UHAS is in position to help Medicaid MCOs deal with a variety of actuarial issues. Our Medicaid group can:

• Help negotiate/advocate for higher rates with actuarial credentials using historical and current financial/utilization experience and any other tools at our disposal
• Analyze financial and medical management reports in order to identify services where potential savings or rate relief can be sought
• Help you understand various revenue-related issues such as risk-adjustment methodologies, pass-through payments, episode-based fees such as maternity, etc.
• Help you develop an accurate and comprehensive budget forecast by rate-cell and service category complete with adjustments for medical trend, contracting and plan design changes, management initiatives, membership projections, administrative costs, etc.
• Assist you in the development of monthly expense including IBNR and other reserves, changes in contracting, changes im membership profile and the identification of sources of gains and losses
• Provide actuarial expertise for internal management meetings and when reporting to your board

Our Medicaid group is headed by Ben Brandon FSA, MAAA, who not only was the Director of Actuarial Services at one of the largest Medicaid MCOs in the country, but is also a member of the CMS Medicaid Rate Certification Work Group of the American Academy of Actuaries. In 2005, this group was responsible for the development of the Medicaid Rate Certification Practice Note that first wrestled with the concept of “actuarial soundness” and is still referred to today by rate-setting actuaries around the country.