Medicaid
Medicaid
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HHS’s Medicaid provider spending data: Use cases and considerations for state agencies and managed care organizations
We outline four potential uses of HHS Medicaid provider spending data for state agencies and managed care organizations, including provider anomaly detection.
The evolving landscape of anti-obesity medication coverage in Medicaid
We expect states to continue balancing the coverage of anti-obesity drugs with immediate budget risks, as cuts to federal Medicaid take effect.
Savings with an asterisk: The hidden math of Medicaid enrollment movement
Using our interactive tool, see how changes to Medicaid managed care coverage policies under new eligibility and enrollment requirements could impact total cost of care.
CMS's new ACO LEAD model: What the Medicare–Medicaid integration opportunity could mean for states, plans, and providers
We explore what the Medicare-Medicaid integration opportunity could mean for states as the CMS’s new ACO LEAD model details are released.
Performance management in Medicaid managed care programs
We outline current challenges State Medicaid agencies may face in their managed care programs, and offer some considerations and potential mitigation strategies.
6 things life sciences companies need to know about risk adjustment
What should life sciences companies know about risk adjustment for the Medicare, Medicaid, and ACA markets?
From complexity to clarity: Aligning operational processes to unlock risk adjustment insights
We examine how leading healthcare organizations operationalize risk adjustment to improve accuracy, compliance, and financial sustainability.
Optimizing risk adjustment operations: Collaborative solutions for Medicare Advantage, Medicaid, and ACA plans
Understanding the risk adjustment (RA) landscape—its definitions, challenges, and key stakeholders—is the first step to building stronger RA performance.
340B Rebate Model Pilot Program—Medicaid implications and considerations
What state Medicaid programs should know and do ahead of the January 2026 launch
Mental health parity and Medicaid
Continued efforts at parity implementation and enforcement in state Medicaid agencies
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