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Andrew Gaffner, FSA, MAAA

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 is an actuary with the Milwaukee office at Milliman. He joined the firm in 2012.

Experience

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

Public program consulting experience

Andrew has devoted much of his career to working with Medicaid healthcare programs. Andrew's area of expertise is Medicaid and managed Medicaid programs, both from a state and managed Medicaid plan perspective. He has assisted clients on multiple Medicaid issues, including:

  • 2014 Medicaid rate setting for the Minnesota Medicaid Department of Human Services for the Prepaid Medical Assistance Program and 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 and assisting states with incorporating primary care physician increases to Medicare reimbursement levels.
  • Assisting Mississippi with projecting Medicaid costs for purposes of creating a fiscal year 2014 and fiscal year 2015 budget.
  • Developing a data book to assist Medicaid managed care organizations in developing bids for Florida's Statewide Medicaid Managed Care program.
  • Creating actuarially sound rate ranges to evaluate bids from Medicaid managed care organizations for Florida's Statewide Medicaid Managed Care Program.
  • Evaluating Medicaid managed care rates and providing negotiation support for Medicaid health plans and provider organizations.
  • Assessing the feasibility of participating in CMS Dual Eligible Integration opportunities.
  • Developing risk scoring methodology and assisting health plans in understanding the process in the Minnesota Care Program.

Previous public program experience

Prior to joining Milliman, Andrew spent seven years with a Medicaid managed care company. Some of his experience there includes:

  • Establishing adequate reserves for outstanding medical liabilities
  • Evaluating Medicaid managed care rates and provide negotiation support
  • Projecting Medicaid costs for purposes of creating a budget
  • Completing financial reporting to assist states with developing actuarially sound capitation rates
  • Work at Milliman

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