Government & Nonprofit Consulting

Government and nonprofit consulting that impacts the state of U.S. healthcare.

Wakely is a leader in government and nonprofit healthcare consulting. We regularly partner with divisions of state government, state-based marketplaces, and other nonprofit organizations on a wide range of projects. These projects include market stabilization and reform analyses in conjunction with 1332 State Innovation Waivers, Essential Health Benefits and standard plan design support, rate filing review, state Medicaid actuarial support, and many others.  

Our expert actuaries and consultants have decades of experience assisting government and nonprofit healthcare clients, helping them predict and navigate the impact of policy changes, market reforms, and more. 

Wakely’s government and nonprofit services  

Wakely offers consulting and actuarial services to support government and nonprofit healthcare clients in these areas and more.

Wakely has worked with both the federal government and numerous states to model the impact of:

  • ACA regulatory changes
  • Medicaid redetermination
  • Enhanced premium subsidies
  • State-based market reform initiatives

This work is enhanced by our deep policy knowledge as well as our proprietary ACA databases. We are also skilled at the efficient collection and analysis of detailed state-specific data to inform policy decisions. 

Wakely partners with states to perform market stability, coverage, and affordability analyses for the individual and small group commercial markets. Sample projects include the analysis of:

  • The impact of state-based reinsurance programs
  • The effects of state-based premium or cost-sharing subsidies
  • The impact of policy decisions on rural or underserved populations

Our estimates take into consideration a range of potential consumer responses to policy decisions, including coverage take-up and attrition, coverage buy-downs (or buy-ups), market migration, and the subsequent impact on market morbidity.

Wakely has supported numerous states with their 1332 applications, from state-based reinsurance to more complex policy programs, such as the Colorado Option. Post-application, Wakely continues to support these states with:

  • Periodic CMS reporting
  • Monitoring state expenditures
  • Revising program parameters to align with legislative changes

Wakely analyses have also been used in premium and cost-sharing wrap programs and cost-containment studies.   

Wakely has worked with several states on the feasibility of changing their Essential Health Benefits (EHB) benchmark, and then supported these states in their application to CMS. This work involves:

  • Comparing benefits and associated costs of select plans
  • Determining pricing of any proposed benefit changes
  • Factoring in new, innovative benefits to address social determinants of health issues, the opioid crisis, and other areas of concern

We have also aided states in EHB, helping them adjust benefits to avoid discriminatory effects and put together new plan documents as part of the application process.

While there are federal standard plan designs in the ACA market, many states have their own standard plans. These plans often align with other state-based policies such as decreasing out-of-pocket expenses through cost-sharing wraps or additional premium subsidies for low-income members. Wakely supports multiple states on their development and/or review of standard plan designs. Our experts work with stakeholders and advocates to ensure access to care while also keeping premiums affordable.

Since the inception of the Affordable Care Act, Wakely has reviewed individual and small group commercial rate filings for several states to ensure actuarial soundness and compliance with all aspects of the law. Our rate review includes:

  • Performing outlier analyses and compiling historical carrier trends for easier review of the overall health and trends of the market
  • Balancing the views of multiple stakeholders
  • Presenting recommendations in an easy-to-understand format

Because many states lack the resources to handle all the necessary Medicaid actuarial tasks within their organizations, Wakely supports state Medicaid programs with critical services such as:

  • Setting Medicaid managed care organization (MCO) rates
  • Performing Medicaid risk adjustment to appropriately allocate the managed care rates to each MCO based on the health of their members
  • Calculating the impact of other strategic changes in policy and recommending the most appropriate course of action
  • Aiding strategic planning and implementation of Section 1115 Demonstration Waivers and state-directed payment programs

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Wakely products for government & nonprofit organizations

Wakely has developed these industry-leading products and tools, which empower our clients to make highly informed strategic decisions.

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Wakely ACA Database (WACA)

Contains the most robust and detailed ACA data available in the industry.

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Wakely Medicare Repricing Analysis Tool (WMRAT)

Aids the comparison of payment rates across multiple lines of business, categories of service, geographic locations, and providers.

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Michael CohenBy Michael Cohen
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Michael CohenBy Michael Cohen