Enabling sustainable investment in social interventions: A review of Medicaid managed care rate-setting tools

Social factors have a substantial impact on healthcare outcomes and spending, particularly with respect to lower-income populations. As the nation’s largest payer for healthcare services for lower-income populations, Medicaid is front and center when it comes to these issues. This report coauthored by Milliman’s John Meerschaert and Shelly Brandel identifies practical strategies that states can deploy to […]

Medicaid risk-based managed care: Analysis of administrative costs for 2016

In this report, Milliman consultants summarize calendar year 2016 administrative costs of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners (NAIC) annual statement. The primary purpose of the report is to provide reference and benchmarking information for certain key administrative expense categories used in […]

Medicaid risk-based managed care: Analysis of financial results for 2016

This report by Milliman’s Jeremy Palmer and Chris Pettit summarizes calendar year 2016 financial results of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners (NAIC) annual statement. The primary purpose of this report is to provide reference and benchmarking information for certain key financial […]

Changes to actuarial soundness requirements may or may not accompany changes to Medicaid funding

Proposals to change federal funding for state Medicaid programs using block grants or per capita caps could affect federal actuarial soundness requirements for Medicaid managed care capitation rates. In this article, Milliman’s Michael Cook discusses the following three scenarios that could play out if changes to Medicaid funding happen. • The continuation of federal actuarial […]

Considerations for Medicaid reform proposals

Republican Medicaid reform proposals have thus far focused on converting federal funding from the current approach of proportional federal and state financing to either block grants or per capita caps. While these funding approaches may sound relatively straightforward, understanding the implications of such changes requires consideration of several factors. In this paper, Milliman consultants break […]

Medicaid encounter data: The next national data set

Quality encounter data is necessary for successful Medicaid managed care programs. States and managed care organizations have partnered to work toward solutions for developing and transmitting complete and accurate encounter data. In this article, Milliman’s Jennifer Gerstorff and WellCare Health Plans’ Sabrina Gibson discuss the need for, and challenges of, collecting Medicaid encounter data as […]