Coverage and Access

Sample Engagements

Setting the Course for Change
Ensuring Success for Medicaid Managed Care
In the face of inadequate Medicaid premium revenue and low enrollment, MHS assisted New York's provider-sponsored managed care plans in establishing a coalition of 14 plans serving over 60% of the State's 2.5 million publicly insured managed care members. Through sophisticated policy analysis and by developing strong working relationships with state and local government officials, MHS has helped the coalition inform public policy on Medicaid managed care and on the hurdles faced by Medicaid beneficiaries in the application and recertification process. The coalition has helped position New York's provider-sponsored health plans as critical participants in the managed care market.

Translating Policy into Practice
Implementing Medicaid Citizenship Documentation Requirements
When federal officials began implementing newly enacted Medicaid citizenship documentation requirements, states, healthcare providers and consumer advocates feared the results could be disastrous. MHS was retained by a leading private foundation to provide an in-depth assessment of the New York State Medicaid program's experience with citizenship documentation (one of only four states that already required such documentation) and the "lessons learned" from New York's model. Drawing on legal research, interviews with Medicaid officials, and a roundtable discussion with Medicaid front-line enrollers, the report makes recommendations to support successful implementation at the state level and ensure access to coverage for eligible citizens.

Forging Alliances for Better Care
When inadequate Medicaid reimbursement rates forced a major home care agency to stop providing home nursing services to children, it turned to MHS for help. MHS helped forge a statewide coalition of children's advocates, children's hospitals, and others to advocate for change. The coalition published a report illustrating the inadequate rates that were leaving children at risk for placement in costly institutions and documenting the hardship on children, families and healthcare providers. Through an intensive government advocacy effort, the coalition was able to obtain passage of legislation increasing home nursing reimbursement rates and expanding access to case management services for medically fragile children in New York.

Making the Case at All Levels of Government
Protecting Prescription Drug Benefits for the Underserved
With the rollout of the new Medicare prescription drug law on the horizon, MHS was engaged on behalf of a national consumer advocacy organization to assist them with administrative and legislative advocacy at the state and federal levels. Navigating the complicated intersections between Medicare and Medicaid, the Firm developed a white paper, addressing the risks of changing prescription drug benefits for the poorest Medicare beneficiaries (so-called "dual-eligibles") from Medicaid to Medicare. Our findings and recommendations were shared with key elected and agency officials, as well as the media and other stakeholders, providing a blueprint for solutions to the crucial issues.