OBBBA work requirements start Jan 2027 · Nebraska begins May 2026 · self-employed enrollees face 73% projected coverage loss
agenticHSA
medicaid today · hsa when you graduate

Keep your Medicaid. Unlock your HSA when you graduate.

You're self-employed. Income goes up and down. Under OBBBA, states can't verify your 1099 income automatically — so you'll lose Medicaid unless someone proves you're working. When your income rises above the Medicaid threshold, the same agent pivots you to an HDHP and opens your HSA. One membership. Every life stage.

Join ComfortCard · $39/mo How it works
no w-2 needed · 1099 + Stripe + Plaid + GitHub · HIPAA-safe
if any of this is you

You'll be automatically disenrolled unless you document.

you are self-employed
73%
Urban Institute projects 73% of self-employed Medicaid enrollees lose coverage because states cannot automatically verify 1099 income, under low-mitigation scenarios.
you care for family
52%
If you live with a disabled family member you may serve as caregiver for, 52% will lose Medicaid because states cannot automatically determine caregiving status.
you have a health condition
62%
If you have a condition that inhibits work, 62% will lose Medicaid despite qualifying for a medical frailty exemption — because they can't document it.
Source: Urban Institute / Robert Wood Johnson Foundation · March 2026 · low-mitigation state scenarios
the agentic layer

Five agents run in the background. Every month. For you.

You connect your accounts once. We attest continuously. Your ComfortCard wallet holds every document a state agency could ever ask for.

1

Income agent

Pulls your 1099 payments, Stripe/Gusto/PayPal payouts, and bank deposits. Produces a signed monthly statement showing you earned the 80-hour federal-minimum-wage equivalent. No W-2 needed.

connectors · Stripe, Plaid, Gusto, PayPal
2

Work-activity agent

Pulls timesheet signals from your calendar, GitHub commits, Linear/Jira tickets, Notion edits — whatever your stack is. Categorizes hours against OBBBA-qualifying work activity.

connectors · Calendar, GitHub, Linear, Notion
3

Exemption agent

Screens you against all 8 OBBBA exemption categories: medical frailty, caregiving, pregnancy, SUD, disability, foster youth, veteran, TANF. Routes medical cases to a licensed physician for attestation.

physician overlay · altru.care
4

HSA graduation agent

You can't contribute to an HSA while on Medicaid — IRS rules. The moment your income crosses the threshold and you're about to lose Medicaid, the agent flips: routes you to the best HDHP + HSA for your state, opens your account, unlocks the tax advantage the same month.

flips at graduation · irs-correct
5

Submission agent

Files your attestation packet directly to your state Medicaid agency where e-filing exists (starting with Nebraska, which begins May 2026). For others, we pre-fill the forms for you to submit.

direct submission · Nebraska first
6

ComfortCard wallet

Every attestation, every statement, every physician letter lives in your ComfortCard health identity wallet. Auditable. Portable. Yours forever — even if you cancel.

identity · persistent · digital
one membership · everything included

AgenticHSA runs inside ComfortCard.

ComfortCard is your health identity wallet. AgenticHSA is the engine that keeps your coverage. One membership. Two products. Zero paperwork.

screen only

$0 · one-time

Am I at risk?
  • Eligibility check — are you in a projected-loss subgroup?
  • All 8 exemption categories screened
  • Your ComfortCard wallet created (free forever)
  • Monthly CMS-guidance email updates
Free screen
comfortcard protected

$39 · per month

Keep coverage now. Unlock HSA later.
  • All 6 agents running monthly
  • Direct submission to state Medicaid (where available)
  • Physician attestation overlay (up to 2/yr, via altru.care)
  • Automatic graduation to HDHP + HSA when income crosses threshold
  • Full ComfortCard health identity wallet — yours forever
  • Cancel anytime · wallet stays yours
Join ComfortCard Protected
how the ecosystem connects

Three brands. One mission. Your coverage, protected.

Wallet
ComfortCardyour digital health identity · holds every attestation, ID, HSA, Medicaid card
Engine
AgenticHSAfive agents that run monthly · produce the attestation packet · this page
Physician
altru.care · Dr. Josh Emdur DO50-state licensed · first named attesting physician · medical frailty review
Marketplace
ClinicalSwipethe B2B marketplace where Medicaid MCOs buy frailty attestations for their whole member books
Consumer
medfrail.comone-off attestation for enrollees who need a single document, direct-pay $99
Join ComfortCard Protected · $39/mo
no w-2 required · cancel anytime · wallet stays yours