MEDICAID

Medicaid & State Children’s Health Insurance Program (SCHIP)

The Medicaid program varies across the states, and national data are limited. Federal waivers support additional variability in state programs. Today, many states deliver care to Medicaid beneficiaries through managed care contracts, resulting in highly variable care delivery and payment even within individual states. States are under budget pressures and are continually looking for ways to manage their Medicaid program costs to maximize Federal dollars and limit increases in state cost. With the recession, states experienced increased demand for care as unemployment rates increased leaving more families without health insurance. SCHIP programs are under similar cost pressure.

Medicaid expansions further exacerbate state budget issues, and challenge states to adapt. Federal initiatives are underway to blend Medicare and Medicaid programs for patients eligible for both programs (dual eligibles). These patients are among the most expensive patients due to age, disability, and multiple chronic diseases. Federal initiatives are also exploring all-payer primary care program innovations. As Medicaid enrollment increases, providers need to adapt to increased demand, and manufacturers and suppliers face increased variations and changes to decision making that can affect access to their products.

The Moran Company is building data and policy capacity to support clients’ needs to better understand change in the Medicaid policy environment, including variation across states. Our consultants have experience working with states and Medicaid health plans in a variety of managed care, fee-for-service, and selective contracting payment environments. We are also prepared to work with a wide variety of organizations on innovation in health care delivery for the dual eligible population.