Medicaid consulting services — State agencies


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Milliman offers state agencies a broad perspective on Medicaid services, helping them better evaluate risk, manage costs, and address the unique issues facing their organizations.

State government health plans face a constantly shifting landscape, including the challenge of estimating future costs, especially with healthcare reform in full swing. Milliman offers state agencies extensive Medicaid experience, in part due to our work with 25 state agencies over the decades. We also have deep experience working with county mental health plans, managed care organizations, and providers—giving clients a reliable industry perspective.

At Milliman, our goal is to help our clients develop realistic scenarios that meet their needs. State agencies working with us receive:

  • Unparalleled actuarial experience. We have unparalleled expertise in developing cost projections and providing financial analysis for the various Medicaid populations.
  • Comprehensive financial analyses. We offer thorough financial analyses for the Medicaid program, with access to vast internal and external data resources.
  • Innovative solutions. We have the expertise and creativeness to come up with new paradigms, such as our development of the Wisconsin Family Care risk-adjustment mechanism, the first of its kind in the industry.

Some typical service areas include:

  • Managed-care capitation rate setting and certification. 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 and availability of data. Our goal is to help our clients develop realistic scenarios that meet their needs.
  • Federal reporting and analysis. Milliman develops robust projection models to give financial budget projections for state agencies, taking into account fiscal impact of any proposed legislation. Our consultants also help agencies develop filings and complete cost-effectiveness documentation for 1115, 1915(b) and 1915(c) federal waivers.
  • Dual-eligible/LTC programs. We work with many dual-eligible and long-term care (LTC) programs, including analysis of both Medicaid and Medicare costs. We work with nursing home populations and home- and community-based service waivers. Milliman does extensive research on LTC services and consults on related insurance policies.
  • Risk adjustments. We work with many different diagnostic risk adjusters, including Chronic Illness and Disability Payment System, Medicaid Rx, DxCG, Adjusted Clinical Groups, and the CMS Hierarchy for Condition Categories. We know the advantages and disadvantages of each for specific applications. We also can develop a functional-needs risk adjustment systems for state agencies, like the one we created for Wisconsin’s Family Care program, which relies on the enrollee’s functional needs, rather than needs based on location.
  • Healthcare reform assistance. With rich experience on proposals for state, national, and international healthcare reform, Milliman can give sound advice on the expected impact of the ACA on all parties—providers, consumers, employers, insurers, and governments.

Get started

Please contact us to learn how Milliman can help your state Medicaid agency better estimate risk, manage costs, and prepare for healthcare reform.

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