With Medicaid, stakeholders must navigate the complicated and highly-regulated system of requirements set forth by the Centers for Medicare and Medicaid Services (CMS). They also face rising expectations on cost containment and must deal with Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). Milliman helps clients sort through it all, offering a team of experts with diverse actuarial, operational, and market experience, spanning decades in the realm of government health care services.

Milliman gives clients an advantage by offering a variety of differentiators, such as:

Unparalleled actuarial experience.

We develop cost projections and provide financial analysis for the various Medicaid populations, and we are familiar with and understand all applicable Actuarial Standards of Practice and American Academy of Actuaries guidelines.

Comprehensive financial analyses.

We offer comprehensive financial analyses for the Medicaid program, including current and future financial budgets and the fiscal impact of proposed legislation.

Innovative solutions.

We have the expertise and creativity 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. The model relies on the enrollee’s functional needs, rather than needs based on location.

Our work covers all facets of Medicaid, tapping not only institutional expertise, but also vast data resources that give clients actionable choices. Some 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.

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.

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.

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 for providers, insurers, and governments.