Government Healthcare Consulting Solutions

State Government Health

State Government Health

Medicaid Reform

Guidehouse helps states manage, streamline and reform their largest budget expenditure, Medicaid, through a number of  tailored solutions. We help states implement value-based payment systems, including Medicaid managed care and other waiver programs, and support programs that integrate physical and behavioral health, as well as long-term services and supports (LTSS) programs.

Our knowledge of leading practices and practical experience working with key state and government agencies provides a rich perspective that we are able to share with all our clients. Our solutions include:

Delivery System Reform
We support states in considering options for reforming their Medicaid programs to achieve higher quality in a cost-effective manner. We provide extensive subject matter expertise, conduct national and state-specific environmental scans, and facilitate stakeholder outreach activities to obtain input on potential reforms. We develop reports of findings and provide recommended options for reforms.

Waiver Programs
We write waiver submissions to CMS, including 1115, 1915 and 1332 waivers. We help manage implementation of waiver programs, including developing ongoing contract monitoring strategies and reporting tools, assist states with CMS negotiations to obtain approval.

Medicaid Managed Care
We assist states with assessing their compliance with new CMS managed care regulations. We design procurement documents; provide support on stakeholder engagement; assess provider network adequacy, performance measures, stakeholder communication, contract development, federal compliance; assist with readiness reviews and corrective action plans, and assist with the full spectrum of managed care design, implementation and contract monitoring. We evaluate and implement pay-for-performance programs.

Managed Care Organizations
We assist managed care organizations (MCOs) to develop strategies and meet contractual requirements for government healthcare program requirements. We address issues including network adequacy, compliance, care/case management requirements, and medical loss ratio guidelines in conjunction with the Medicaid managed care final rule.

State Innovation Models Initiative
Guidehouse helps states using State Innovative Models funding to implement the program’s payment transformation agendas through program design, data analytics, performance metric development, and program effectiveness monitoring, evaluation and system design.

Behavioral Health
We work with states to integrate acute and behavioral health services, facilitating more coordinated care with less duplication, and better care management and outcomes. We offer a number of services to support this transition, including program design to educate primary care physicians about behavioral health issues and the need for coordinated care.

Develop Approaches for Medical Homes, Health Homes, and Patient-Centered Medical Homes
We develop and design programs and financing strategies, support implementation and monitor programs. We also develop curriculum and train physicians and their staff on issues related to medical homes.

Guidehouse has prepared a section-by-section reference of the CMS-proposed Medicaid Fiscal Accountability Rule (MFAR). This document provides a brief summary of each proposed, newly created, or amended CFR section, and a reference to the pages in the proposed rule where the new regulatory language and CMS commentary can be found. A complete breakdown of the CMS-proposed MFAR can also be accessed. In addition to the summary, this document provides commentary for the new language. This is a good document to review for insight into CMS policy goals in the proposal of MFAR, and an understanding of how MFAR may impact day-to-day Medicaid finance operations at the state level.

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