States participating in the Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative are working to adopt evidence-based prevention strategies for Medicaid populations in six high-opportunity areas: control asthma, reduce tobacco use, prevent type 2 diabetes, improve antibiotic use, and prevent unintended pregnancy. A core piece of implementing a new prevention-focused intervention in Medicaid is demonstrating how the benefit may impact short- and long-term Medicaid costs. Understanding how public health and Medicaid agencies can work together to demonstrate the financial implications of new Medicaid benefits is an important step in making the business case for policy adoption.

This webinar, made possible by the Robert Wood Johnson Foundation for the states participating in the 6|18 Initiative, offers Medicaid and actuarial perspectives on conducting financial analyses to build the business case for new or expanded Medicaid prevention policies. The discussion explores how state public health officials can partner with and assist Medicaid to make the business case for new or expanded Medicaid investment, with a specific focus on the adoption of new prevention policies promoted by the CDC’s 6|18 Initiative. The conversation also addresses areas of concern for actuaries working in a Medicaid managed care setting as they review the expected costs or savings for new interventions and how to factor in managed care organization characteristics, including contracting relationships.


I. Welcome and Introduction

II. Public Health and Medicaid: Making the Case for a Benefit Expansion or Change

Speaker: Tricia Leddy, Faulkner Consulting

Tricia Leddy will describe a step-by-step process for gathering the necessary data and information to develop and make the case for a benefit expansion or change. She will also share examples from her work with Rhode Island.

III. 6|18 Case Study: Utah

Speaker: Brittany Guerra, Asthma Program, Utah Department of Health

Brittany Guerra will share Utah’s experience of pursuing Medicaid coverage for an asthma home visiting program, including making the business case to policymakers and health leaders.

IV. How Actuaries Think: Medicaid Managed Care Organizations and New Programs

Speaker: Rebecca Owen, HCA Solutions, Inc.

Rebecca Owen will delve into the actuarial thought process, providing insights into the way health plan actuaries evaluate new benefit proposals in Medicaid managed care programs.

IV. Moderated Q&A