Government and Non-Profit

Our actuaries and policy consultants are dedicated experts in the field of government and non-profit consulting. We partner with divisions of state government, state-based marketplaces, and other non-profit foundations and organizations on projects including, but not limited to, individual and small group rate filing review, market stabilization analyses in conjunction with 1332 State Innovation Waivers, and state Medicaid actuarial support.

Market Stability / 1332 Waivers

States should be using detailed state-specific data to inform their policy direction. The most important action they should be taking now is collecting data and performing analyses to better understand the current market and how potential changes would impact them.

Wakely partners with states to perform market stability analyses for the individual and small group commercial markets. Through a proprietary process, Wakely creates a statewide database from data files readily available from carriers which is used to perform analyses that can inform the state's stability or reform initiatives. Sample analyses include analyzing the impact of state-based reinsurance programs or high risk pools and the impact of policy decisions on rural communities. 

In addition, states can use the results of the analyses to complete 1332 State Innovation Waivers to waive portions of the Affordable Care Act in order to implement programs to stabilize the market. 

USA Healthcare

Rate Filing Review

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. As part of rate review, Wakely performs outlier analyses and compiles historical carrier trends so states can better review the overall health and trends of the market. As part of rate review, Wakely prioritizes balancing the views of multiple stakeholders and presents rate review recommendations such that the desired audience can easily understand the results. 

Medicaid Actuarial Support

Many states do not have the capability to perform all of the necessary Medicaid actuarial needs within their organizations. Wakely supports state Medicaid programs through 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, and calculating the impact of other strategic changes in policy and recommending the most appropriate course of action. Wakely also supports states in their strategic planning and implementation of Section 1115 Demonstrations waivers.

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