Medicaid Consulting Services

Overview

Applying a trusted combination of knowledge, research, and analytics

The breadth and depth of knowledge available through the Milliman Medicaid Consulting Group lets us create customized solutions for our clients in an effective, efficient, and timely manner. Our actuaries and consultants offer client-focused solutions to Medicaid rate-setting and other key financial analysis while also providing regulatory guidance and ensuring compliance with all our projects.

MEDICAID MEDICALLY FRAIL DETERMINATION

Milliman Medicaid Frailty Solution

Milliman is uniquely qualiﬁed to assist states in implementing medically frail determinations for their Medicaid populations as required under HR1. Medically frail determinations need more than just a technological change order. The Milliman Medicaid Frailty Framework combines Milliman’s proven and industry leading software with actuarial, policy, and clinical consulting knowhow to provide a solution that goes beyond the ones and zeros to support states with financial modeling and policy analysis.

Learn more

Actuarial consulting

With more credentialed healthcare actuaries than any other firm in the United States, we have unparalleled expertise in actuarial consulting, covering a wide scope of Medicaid-related needs.

Services offered include the following.

Capitation and rate setting and certification
Budget forecasting
Federal waiver development – 1115, 1915b, 1915c, 1332
Risk adjustment and risk mitigation mechanisms
Savings opportunity analyses
MCO RFP evaluation and assistance

Capitation and rate setting and certification

Review and summarization of encounter data
Analysis of MCO financial information
Future medical cost projections
Administrative cost benchmarking analysis
Rate setting for various program types including, but not limited to, acute care, Long-Term Services and Supports (LTSS), specialty populations, PACE, dental, and NEMT

Finance consulting

The Milliman Medicaid Finance team’s expertise in design, implementation, and evaluation of healthcare delivery, payment, and rate-setting systems for all types of provider services simpliﬁes the landscape for state agencies. Our ﬁnance consulting services complement Milliman’s actuarial and policy practices, oﬀering clients a single source solution that addresses the complexities of the Medicaid program.

Medicaid program funding strategy
Hospital payment and rate-setting systems
Supplemental payment program strategy
Long-Term Services and Supports (LTSS) payment systems

Medicaid program funding strategy

Design and implementation of healthcare-related tax programs (provider assessments)
Intergovernmental Transfers (IGTs) and Certiﬁed Public Expenditures (CPEs)

Policy consulting

With a diverse team of consultants with real-world experience at state Medicaid agencies, MCOs, and healthcare providers, our policy team applies a practical operations approach to policy initiatives with a focus on feasibility and ease of adoption. Partnering closely with Milliman’s actuarial, finance, and clinical experts, we seamlessly deliver tailored solutions for Medicaid state agencies. Our policy consulting services include the following:

Waiver development, healthcare reform, program development, and enhancements
Program conceptualization, design, and implementation
Managed care and administrative services/vendor operational support

Waiver development, healthcare reform, program development, and enhancements

1115, 1915, 1332, emergency waivers, and state plan amendments
Delivery system reform and value-based payment
Managed Long-Term Services and Supports (MLTSS)
Behavioral health transformation
Dual demonstrations/financial alignment initiatives
High cost drugs
Premiums assistance programs and Medicare savings programs
Quality strategy
Social determinants of health

Insight

Related insight

Article

COVID-19 vaccine administration options under Medicaid

Medicaid has an important role to play in ensuring coverage of and access to the COVID-19 vaccine.

Read the article

Article

Meeting the needs of Medicaid Home and Community-Based Services program participants during the COVID-19 pandemic and beyond

The COVID-19 pandemic presents unique challenges for Medicaid Home and Community-Based Services program participants.

Read the article

Article

Updated eligibility maintenance options for state Medicaid programs to qualify for 6.2% FMAP during the COVID-19 emergency

Centers for Medicaid and Medicare Services has published a rule updating this interpretation, creating new compliance requirements for states in order to continue receiving the enhanced FMAP.

Read the article

Article

Medicaid managed care financial results for Q3 2020

Since March 2020, the levels of medical service utilization have affected payers, providers, and healthcare markets differently and dampened medical expenditures has been a consistent theme.

Read the article