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Andrew Gaffner, FSA, MAAA

Principal and Consulting Actuary
Brookfield, WI, US

Tel: +1 262 7842250

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Professional Designations

  • Fellow, Society of Actuaries
  • Member, American Academy of Actuaries

Education

  • BS, Management, Georgia Institute of Technology, 1998

Current Responsibility

Andrew Gaffner is a principal and consulting actuary with the Milwaukee office of Milliman. He joined the firm in 2012.

Experience

Andrew has assisted clients across the health insurance industry, specifically in the area of managed healthcare programs. He has advised state government agencies, hospital systems, insurance companies, MCOs, and other healthcare clients. His experience with Medicaid coverage from the perspective of insurers, providers, and government stakeholders enables him to provide unique insight on a wide range of issues.

Public program consulting experience

Andrew’s area of expertise is Medicaid and managed Medicaid programs from both a state and managed plan perspective. He has assisted clients on multiple Medicaid issues, including:

  • Serving as the certifying rate-setting actuary for the Minnesota Medicaid Department of Human Services under the Prepaid Medical Assistance Program and the Minnesota Care Program
  • Leading the development of a risk scoring methodology and assisting health plans in understanding the process in the Minnesota Care Program
  • Evaluating the impact of the Affordable Care Act on state Medicaid programs, including analyzing the effect of membership movement in Minnesota
  • Developing a Data Book to assist Medicaid managed care organizations in developing bids for Florida’s Statewide Medicaid Managed Care (SMMC) program
  • Creating actuarially sound rate ranges to evaluate bids from Medicaid managed care organizations for Florida’s SMMC program
  • Serving as the certifying rate-setting actuary for NEMT, Dental, and Children with Medical Services Network capitation rates for Florida’s SMMC program
  • Modeling provider reimbursement rates for outpatient and inpatient hospital services for Florida’s SMMC program
  • Creating opioid tools to predict members who will receive an opioid use diagnosis in the near future
  • Creating a nationwide study evaluating the prevalence of Hepatitis C among state prison and Medicaid members, as well as determining the long-term costs and savings for providing various treatments
  • Evaluating Medicaid managed care rates and providing negotiation support for Medicaid managed care organizations
  • Assessing the feasibility of participating in CMS Dual Eligible Integration opportunities
  • Work at Milliman

    • “I was offered a chance to come in, shake things up, create something."
    Work at Milliman