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Data-driven insight. Deep expertise. Transformative innovation. Since 1947, Milliman has delivered intelligent solutions to improve health and financial security.
Regulatory complexity makes Medicaid a challenging market for all concerned—governments, providers, and plans alike. Milliman helps you find the best way forward. Our experts have diverse actuarial, operational, and market experience from decades in the realm of government healthcare services.
Milliman has an extensive background working with states on Medicaid managed care rate setting. We value our working relationships with our Medicaid state agency clients and use a collaborative process to ensure transparency and open communication.
Milliman works with health plans to navigate all of Medicaid's complexities. With our unparalleled actuarial expertise, we help plans understand their populations, evaluate capitation rates, and optimize provider relationships.
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.
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.
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.
With experience working on state, national, and international healthcare reform, Milliman can give sound advice on the expected impact of the ACA for providers, insurers, and governments.
We have the expertise and creativity to come up with new paradigms, such as our development of the Wisconsin Family Care needs-based risk adjustment mechanism, the first of its kind in the industry.
As a new federal law, effective in 2024, removes a cap on manufacturers' drug rebate amounts, we explore the implications for state Medicaid programs.
We review the essentials for states to consider regarding the proposed changes by CMS for Medicaid and Children’s Health Insurance Program Managed Care Access.
As drug costs continue to rise, states need to engage in strategies that include policy and nonpolicy options to manage prescription spending in Medicaid.
This report provides an analysis of the recently released 2021 Centers for Medicare and Medicaid Services (CMS) Medicaid and Children’s Health Insurance Program (CHIP) Scorecard.
Uncertainty remains regarding COVID-19’s impact on Medicaid MCO financial performance, including the deferral of care, pent-up demand, and future claims.
A summary of available data sources that can assist state Medicaid agencies in evaluating health disparities and measuring progress toward health equity goals
Design and implementation of new care models mean a major undertaking for many…
The COVID-19 pandemic presents unique challenges for Medicaid Home and Community…
This brief scopes out the issue of homelessness and housing security and…
This report provides an analysis of the recently released 2020 Centers for…
This report provides an analysis of the recently released 2019 Centers for…
State program directors face many complex considerations as they evaluate the…
Gaining Medicaid insights from personal experience.
What is Medicaid, how is it financed, and how did it change under the Affordable…
This article focuses on some of the challenges that Medicaid payers (including…
Managing Medicaid in the face of a natural disaster: in this episode of Critical…
Manage Medicare, Medicaid, and commercial risk adjustment with our award-winning suite of tools and data.
Adopt the healthcare industry’s leading platform for data warehousing and healthcare analytics.
Analyze historical data to inform policy decisions, validate encounter data, understand emerging experience, and more.
Ask the tough questions. We’re ready for them.