Medicaid consulting services — Health plans


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Milliman provides individual and association health plans with comprehensive analyses needed to navigate the myriad requirements for compliance with Medicaid, in addition to preparing them for new rules under the ACA. The end result: more efficiently-run programs.

Health plans must navigate the complexity of complying with government regulations and rules for Medicaid, which has become all the more challenging with the enactment of the Patient Protection and Affordable Care Act (ACA). Milliman helps health plans by offering comprehensive services to get plans up to speed. We gain an understanding of a program’s member composition and the characteristics unique to its population, and evaluate them against best practices. We also take a look at the current healthcare management programs, plans, and capabilities. From our work with 25 state Medicaid agencies, we provide clients with:

  • Unparalleled actuarial experience
  • Comprehensive financial analyses
  • Innovative solutions

Specifically, Milliman assists health plans with needs such as:

  • Capitation rate evaluation. Our consultants apply many different methods and approaches for setting actuarially sound capitation rates. We use both fee-for-service and managed-care encounter data depending on the situation. Our goal is to help our clients develop realistic scenarios that meet their needs.
  • Competitive bid development. We also allow clients to focus on making sound business decisions by understanding all facets of the bidding process. We monitor shifting CMS regulations, freeing clients from worry about bids being rejected because of technicalities. Our support extends beyond bid submission, through desk review and audit.
  • Healthcare reform assistance. With the new exchanges under the ACA, Medicaid health plans will have to adopt some of the practices of the commercial market, such as collecting premiums when their members aren’t eligible for Medicaid. We help plans understand the differences between the two markets so they can keep members in either area. We can also help determine what new enhanced rates plans need to pay primary care physicians under ACA, and assist with Medicaid expansion population modeling.
  • Dual-eligible managed-care demonstration program analysis. The federal government is working with states to create demonstration programs for dual eligibility for both Medicare and Medicaid. Milliman evaluates revenue streams and analyzes potential savings versus costs prior to the demonstration.
  • Provider reimbursement analysis. We also take a close look at reimbursement rates by evaluating fee schedules, examining provider performance and incentive arrangements, and analyzing provider capitation arrangements.

Get started

Please contact us to learn how Milliman can help your plan better manage CMS and state requirements and integrate itself to the new system as a result of healthcare reform.

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