Medicaid

We can help you navigate Medicaid – and transform it.

Medicaid, the state and federal program for low-income individuals and special populations, provides healthcare services for over 70 million Americans. Since the beginning in 2001, SVC, now HMA Medicaid Market Solutions (HMA MMS), has been deeply involved with states, reforming and modernizing this large and complex program.

Waivers

In many states, Medicaid expenditures are one of the single largest line items in the state budget, and in all states, using these dollars efficiently, and directing funds to the greatest needs, is paramount. The HMA MMS team has been instrumental in the development of innovative 1115 Demonstration Waivers for several states, and pioneered consumer directed care with the first such plan, the Healthy Indiana Plan or HIP. Additionally, HMA MMS has worked in Iowa, Kentucky, Ohio, and Michigan assisting with the design, development or implementation of these large demonstration waivers, creating unique programs with the common elements of private market involvement, consumer direction, incentives for prevention and healthy behaviors, and financial contributions by participants. Although similar in concept, each program is carefully and thoughtfully designed to meet the specific needs of each state, taking into consideration the existing healthcare market, the state’s goals and financial resources, the political landscape, the unique needs of the population, and the important input of all stakeholders.

The HMA MMS team has extensive experience in:

  • Designing 1115 Demonstration Waivers and programs
  • Supporting the waiver development
  • Assuring that the proposal is well-structured, contains all of the required elements, and aligns with the state’s multiple needs (programmatic, fiscal, and political)
  • Negotiating the terms and conditions with the Centers for Medicare & Medicaid Services (CMS)
  • Leading implementation efforts, including implementing policy, eligibility system changes, developing requests for proposals, drafting contracting documents, and conducting readiness reviews
  • Leading stakeholder involvement and developing training materials for all audiences.

Special Populations

HMA MMS has led many research efforts involving Medicaid special populations, including the Aged, Blind and Disabled (ABD), those with behavioral health needs, and individuals needing long-term care or Home and Community Based Services (HCBS). The team has assisted states with research, analyses, and program development to improve access and service delivery for these and other special populations.

In Indiana, HMA MMS led efforts to develop the state of Indiana’s Behavioral and Primary Healthcare Coordination (BPHC) program under a Section 1915(i) waiver. This HCBS program was specifically designed to maintain Medicaid eligibility for a portion of the state’s population with chronic mental illness. The HMA MMS team identified the population at risk of losing services, developed policy options for the program design, identified assessment processes, designed the package of services, developed the State Plan Amendment, drafted administrative rules, prepared stakeholder communications, and provided project management and technical support through implementation.

The HMA MMS team also advised and assisted the State of Indiana Aged, Blind and Disabled Task Force, which was convened to complete a comprehensive review of the state’s ABD population, expenditures, programming, and national trends. HMA MMS analyzed public input, researched ABD policy and program options across the country, and considered Indiana’s existing managed care landscape in order to draft the Aged, Blind and Disabled Report for the Indiana General Assembly.

Coverage Expansions

Many states, led by both Republicans and Democrats, have sought to expand Medicaid coverage to a broader population through the Affordable Care Act (ACA). The founder of SVC, now HMA MMS, served as the architect of then Governor Mitch Daniels’ Healthy Indiana Plan (HIP) to expand coverage with an innovative plan of consumer-directed care, and the firm has remained directly involved in HIP program policy and operations, including the development of HIP 2.0 under former Governor Mike Pence.

Additionally, HMA MMS took the lead on new 1115 Demonstration Waiver development in states such as Kentucky, Idaho, Iowa, and Tennessee as they each considered Medicaid expansions, and worked with counties and local health departments as they considered the impact of the ACA and Medicaid coverage expansions on their programming and operations.

Managed Care

HMA MMS, formerly SVC, provides complete support for states considering or implementing a Medicaid managed care strategy. HMA MMS helps states design, develop, and implement managed care programs, leading states through the process from policy design, stakeholder communications, waiver development, and operational needs through post-implementation. This includes identifying policy and program options, and facilitating state decision-making. Specifically, HMA MMS develops:

HMA MMS has provided Medicaid managed care advisory services in multiple states, including Indiana, Idaho, and Iowa.

Cost Containment Strategies

In 2013, Maine’s Department of Health and Human Services contracted with SVC, now HMA MMS, and Milliman to provide research, data analysis, and expertise to redesign the state’s Medicaid cost containment strategies and achieve $5.25 million in savings. The firm reviewed the MaineCare program including analyzing coverage categories, covered benefits, cost-sharing requirements, enrollment trends, and expenditure data, and conducted a nationwide review of Medicaid cost containment strategies in order to develop a successful strategy for the state of Maine. The HMA MMS team helped facilitate the MaineCare Redesign Task Force meetings, prepared analyses and presentations, and drafted the final report to be submitted to the state legislature. Recommendations in the report projected total savings in fiscal years 2013 – 2015 of $35.22 million, and assisted the task force in identifying savings and validating strategies to improve care delivery and realize cost savings.