Medicaid and Long-term Care

Medicaid Tools

Reden & Anders has the experience and tools necessary to assist your organization with your Medicaid at-risk product line. We have helped organizations in more than 30 states with Medicaid analyses. With this extensive experience and a large database of actual Medicaid experience, we have built a solid reputation with state agencies and their consultants.

The experience and resources to evaluate Medicaid opportunities.


Robust Medicaid database

We have assembled a significant database of deidentified Medicaid data. Using this data, we developed actuarial models for Medicaid populations and utilization and cost benchmarks.

With these tools and staff expertise, we can help:

  • Complete the actuarial portion of state requests for proposals
  • Evaluate the financial effect of changes to a Medicaid program, (adding an adult uninsured initiative, including dual eligibles, changes in covered benefits, etc.).
  • Compare a managed care organization’s (MCO’s) Medicaid medical claims experience to Reden & Anders’s benchmarks
  • Evaluate the effect of health status adjusted reimbursement
  • MCOs create Medicaid-specific provider reimbursement strategies

Responding to State RFPs

States use a variety of methods to develop Medicaid at-risk payments. We leverage our Medicaid experience to provide you with valuable insight into these different Medicaid payment structures. Our services include:

  • Reviewing the request for proposal (RFP) and other pertinent state documents to understand significant program issues and bid requirements
  • Gathering data from the health plan or other sources in the format required in the RFP
  • Projecting costs for the period covered by this contract
  • Completing required forms for the bid submission
  • Assisting in discussions with the state to negotiate the most favorable rates

Financial Effect Analysis

Reden & Anders utilizes its proprietary actuarial models to predict the costs of new populations added to the managed Medicaid program. These include dual eligibles, CHIP children, uninsured adults, SSI without Medicare, the frail elderly (PACE), and more.