Succeeding in Medicaid Expansion

The Supreme Court’s recent decision in King v. Burwell affirming the ACA will ensure Medicaid’s continued expansion. With expanded federal funding eligibility, more adults under 65 and children can qualify for Medicaid coverage. 

The opportunities for managed care and other companies are significant: from 2015 to 2024, federal Medicaid spending will increase by $472 billion.

Participating in expanded state-sponsored Medicaid programs can generate significant membership growth for managed care and other companies. However, this growth is not without risk or complexity, given the multiple regulatory changes taking place in the Medicaid managed care environment. 

Members of Freeborn’s Healthcare Practice Group can guide health insurers and healthcare entities from concept to reality by helping them address a range of questions:

  • Financial Assessment: What regulatory obligations will we have if we offer a managed care plan under Medicaid? Are these requirements we can fulfill successfully?
  • Certification and Compliance: Do we need an insurance certificate to offer a plan? If so, how do we get one? Do we implement an “off-the-shelf” compliance plan, or tailor a custom compliance plan to meet state and federal requirements?
  • Medicaid Managed Care Rules: How do the new CMS Medicaid Managed Care Rules impact our business? What aspects of our business do we need to change to comport with the new rules?
  • Delivery Capacity: How do we build a network of providers willing and able to provide services under a managed care model, and which meets state and federal requirements?
  • State and Federal Contracting: How do we engage in a contract with a state government? How do we seek waivers, if needed, from the federal government to implement our chosen business model?

Freeborn’s healthcare attorneys have been directly involved in implementing new Medicaid expansion programs, and they can bring their experience to bear in support of a payer’s goals.