Medicaid

ARC has undertaken a number of studies which focused specifically on the Medicaid program. ARC has  provided consulting services both at the federal level as well as at the state and local level. The firm has been particularly active in developing techniques for setting target capitation rates for prepayment arrangements under Medicaid. Methodologies for setting capitation and premium rates have been developed and tested by private insurers and HMOs over several decades. ARC's approach has been to  adapt those proven methods to Medicaid capitation within the data set typically available to most or all state Medicaid programs.

Most recently, ARC has been active in state Section 1115 and Section 1915 waiver applications, assisting several states with assessing the feasibility of waiver financing and the preparation of waiver applications. ARC is currently assisting the State of Virginia  in developing rates and the selection of HMOs for at risk contracts.

Some of the specific projects involving Medicaid and capitation programs are described briefly immediately below.

• Review of California rate revisions for its Medicaid managed care plans. Assistance in the development of prototype models  for HCFA to use in setting capitation rates for Medicaid managed care plans.
• Compilation of a manual for training CMS regional office personnel in evaluating capitation rates for managed care programs.
• Compilation of a "how to do it" exposition of the "best practices" for forecasting outlays of state  Medicaid programs for the Executive Office of Management Budget after it completed an extensive review of how states budget for their Medicaid programs.
• Actuarial consultants to the State of Missouri in developing a methodology for forecasting capitation rates.
• Estimates of the cost of replacing the Massachusetts Medicaid Program with a state health insurance program.
• Evaluation of the Arizona Health Care Cost Containment System, an experimental prepaid Medicaid program, in terms of costs  with respect to a traditional Medicaid program.