Medicaid consulting services to help organizations respond to change and improve care.
Health Management Associates (HMA) provides comprehensive Medicaid consulting for state agencies, health plans, health systems, and providers. We assist organizations in navigating policy shifts, strengthening compliance, optimizing operations, and moving strategic initiatives into action across Medicaid and CHIP programs. Key capabilities include:
- State Directed Payments and Financing: Evaluating, structuring, and defending complex financing approaches under heightened federal scrutiny.
- Eligibility, Redeterminations, and Community Engagement: Advising on renewals, verification, administrative processes, and compliance requirements tied to changing federal and state expectations.
- Managed Care Oversight and Program Integrity: Strengthening compliance frameworks, oversight processes, risk adjustment, and fraud, waste, and abuse strategies.
- Section 1115 Demonstrations (Waivers): Designing, advancing, and evaluating waiver strategies that support innovation, delivery system priorities, and federal approval pathways.
- In Lieu of Services (ILOS) and Provider Reimbursement: Assessing reimbursement, coverage, and state plan implications to support operational and financial decision-making.
Navigating Medicaid Changes Can Be Complex. You Don’t Have to Do It Alone.
Navigate Complex Regulatory Changes with Confidence
Major policy shifts under the Working Families Tax Cut Act (WFTC) related requirements are rapidly transforming Medicaid eligibility, financing, provider reimbursement, and managed care oversight. Without expert guidance, these shifting regulations present significant financial, operational, and compliance risks. HMA translates complex federal and state mandates into actionable strategies, enabling your organization to reduce disruption and maintain compliance, protect financial sustainability, and maintain seamless care delivery.
State Medicaid Agencies
WFTC changes to eligibility, provider taxes, and managed care oversight create three immediate risks: (1) Federal compliance violations if redetermination processes aren’t updated, triggering funding clawbacks; (2) Enrollment disruptions and administrative burden if systems aren’t modernized; (3) Financing gaps if directed payment strategies aren’t restructured to meet new federal requirements.
Health Plans
Rapid changes to risk adjustment, managed care performance metrics, and network adequacy standards create operational complexity. Plans that don’t proactively align their networks and rate strategies risk: (1) Network compliance violations and state sanctions; (2) Rate-setting errors leading to financial unsustainability; (3) Audit exposure if program integrity controls aren’t strengthened.
Providers
WFTC’s reimbursement changes and new performance requirements threaten margins. Providers that fail to plan proactively may face: (1) Revenue volatility from payment model shifts; (2) Compliance gaps if reporting systems aren’t updated; (3) Contract non-renewal if they can’t demonstrate quality/performance alignment.
40+ Years Leading Medicaid Policy Implementation
For over four decades, HMA has been a trusted advisor across the Medicaid ecosystem.
- Deep Industry Expertise: Our team includes former federal and state Medicaid/CHIP directors, health plan executives, actuaries, and policy specialists.
- Comprehensive Stakeholder Experience: We serve state Medicaid agencies, managed care organizations, health systems, behavioral health providers, and industry associations.
- Full Lifecycle Support: From rate setting and actuarial analytics to quality research and IT platform optimization, from policy design through operational execution tailored to your operational goals.
Medicaid insights you can use.
HMA publishes timely analysis on Medicaid policy, waivers, financing, managed care, reimbursement, and implementation to help organizations stay ahead of change.
Explore related insights, alerts, webinars, and analysis from HMA’s Medicaid experts.
Explore Our Expert InsightsWho HMA helps
HMA works with organizations across the Medicaid ecosystem, tailoring support to each group’s priorities.
State Medicaid agencies: Support for eligibility, financing, oversight, quality, waiver strategy, and implementation planning.
Managed care organizations: Support for compliance, operations, quality, networks, and rate development.
Providers and health systems: Guidance on quality, coverage, payment, reporting, and relationships with states and plans.
Behavioral health and LTSS organizations: Support for access, care coordination, quality oversight, and payment strategy.
Associations and coalitions: Policy analysis and communications to help members respond to change.
Answers to Common Medicaid Questions About Strategy, Compliance, and Implementation
Can HMA help states and health plans with Medicaid rate setting and risk adjustment?
Yes. HMA helps states and health plans with Medicaid rate setting, actuarial strategy, and risk adjustment.
Medicaid Rate Setting: Establishing actuarially sound managed care rates.
Risk Adjustment: Performing Medicaid risk adjustment for state agencies and plans.
Can HMA help modernize Medicaid eligibility, enrollment, and customer service systems?
Yes. HMA helps modernize Medicaid systems and improve the workflows that support enrollment, eligibility, and service delivery.
System Enhancements: Improving eligibility, enrollment, and customer service workflows.
Platform Optimization: Upgrading Medicaid, CHIP, and marketplace systems to better support users and administrators.
Can HMA help with Medicaid 1115 waivers, state plan amendments, and implementation planning?
Yes. HMA helps organizations plan, write, and implement Medicaid policy changes tied to OBBBA, H.R. 1, WFTC-related policy requirements, waivers, SPAs, and broader reform strategies.
Section 1115 Demonstrations: Designing and advancing complex reform initiatives.
State Plan Amendments (SPAs): Developing proposals and documentation to support approval and funding.
Policy Implementation Support: Translating federal and state requirements into operational action.