In the highly visible and often contentious world of healthcare policy, government policy makers look to Milliman for impartial assessments of proposed policies and programs. Our contributions are particularly valued because Milliman's evaluations and recommendations are based on quality data, expert tools, and unbiased analysis.
Milliman also brings to the policy arena knowledge and broad experience with all stakeholders in today's healthcare landscape.
Our consultants have analyzed and developed many different kinds of public programs, including:
- Medicaid acute care and long-term care programs
- State Children's Health Insurance Programs (SCHIP)
- Medicaid and uninsured expansion programs
- 1915(b) and 1915(c) Cost Effectiveness Waiver Filings
- New comprehensive health insurance programs
- Program of All Inclusive Care for the Elderly (PACE) programs
- Medicaid mental health and substance abuse programs
Milliman assists government agencies by analyzing healthcare programs' projections, including population and financial forecasts. We help develop and certify actuarially sound rates for managed care programs, develop waiver filings, and determine fiscal impact caused by legislative policy so that state governments can make informed decisions about policy and budget. We also have assisted many clients to evaluate and use risk adjusters.
Client example: financial forecasting
Milliman consultants have been retained by a state Medicaid agency to develop budget forecasts for the state biennium, monitoring the forecasts monthly and updating them quarterly. Milliman also participates in discussions with the state budget agency and legislative fiscal analysts. Our information has been used as a benchmark in budget negotiations, in analysis of legislative proposals, and in submissions of materials to CMS. With Milliman's involvement, all of the parties often start with a common understanding of the fiscal analysis associated with the Medicaid program.
Client example: new benefit program for the uninsured
A state government recently enacted a new tax, primarily implemented to perform an expansion to the currently uninsured adult population in the state. Milliman was requested by the state Medicaid agency to assist in the benefit plan design, develop actuarially sound capitation rates, participate in health plan negotiations, and develop the cost effectiveness calculations associated with the 1115 waiver. Working with the state program team and other consultants, the Milliman team successfully negotiated the 1,115 cost-effectiveness terms and conditions to expand coverage to approximately 125,000 uninsured lives.
