Medicaid is, without a doubt, the largest budgetary item in virtually every state. Program enrollment and expenditures continue to grow following implementation of the Affordable Care Act, which expanded Medicaid’s reach in many states. Medicaid is a key component of state efforts to increase health insurance coverage and reimagine health care delivery, making Medicaid program administration one of the most challenging undertakings of state government.

There is also an increased focus on developing new service delivery and financing models, including greater reliance on home and community-based care for Medicaid enrollees with long-term services and support (LTSS) needs, rather than institutionalized care.

Among the challenges and opportunities state Medicaid agencies face are cost containment, eligibility determination, care coordination, care integration, and data analytics. Our work encompasses all facets of Medicaid consulting and administration, and we offer services to specifically address these high-priority challenges. Examples of our work include:

  • Through specific financing and claiming initiatives, we have saved $50 billion for the Massachusetts Medicaid program over the life of our partnership.
  • Our health law and economics experts were extensively engaged in the development and implementation of Massachusetts’ health care reform law.
  • We work with states across the country to develop drug management strategies and address the efficacy of high-cost medications. Our pharmacy experts save $25 for each $1 spent on the Massachusetts Medicaid pharmacy program.
  • We develop policies and programs to coordinate care for individuals with complex health care needs, including dual-eligible populations and beneficiaries receiving LTSS, including those served by the Community Case Management program.
  • We have developed data management and analytics tools to evaluate cost and outcomes effectiveness of home and community-based services within Massachusetts.
  • We consult with universities across the nation to develop mutually beneficial university-Medicaid partnerships within their own states.