Marlene is a key contributor to many aspects of actuarial consulting services that are provided to state Medicaid agencies. She has extensive experience with budget forecasting and associated fiscal impact analyses, risk scoring for managed care capitation rate-setting projects, capitation rate development for the dual demonstration, and review of capitation rate methodologies for various Medicaid populations. Her interaction with the different components of state Medicaid programs provides key insight and ensures consistency of program policy across various budget lines, particularly because many policy decisions impact the allocation of eligibility and expenditures throughout the various Medicaid delivery systems.
The following provide specific examples of Marlene's Medicaid experience:
Development of Medicaid capitation rates for traditional risk-based managed care programs (TANF and disabled populations)
Development of Medicaid capitation rates for dual demonstration programs (Community, Nursing Facility, Home & Community-based Waiver populations)
Preparation and management of semi-annual risk adjustment analysis for managed care plans
Preparation and management of quarterly forecasting analyses for Medicaid program budgets
Oversight of provider reimbursement analyses
Professional contributions
Volunteer, Society of Actuaries Education & Examinations Committee, 2012 to present
Speaker, Society of Actuaries Health Meeting, June 2015
Speaker, Society of Actuaries Health Meeting, June 2016
Speaker, Healthcare Education Associates' LTSS and Dual Eligible Beneficiaries Summit, August 2016
Publications and Presentations
Medicaid and the ACA, May 6, 2015. Appeared in May/June 2015 issue of "Contingencies" magazine, published by the American Academy of Actuaries
Professional Designations
Fellow, Society of Actuaries (FSA), 2012
Member, American Academy of Actuaries (MAAA), 2008
Education
BMath, Honours Actuarial Science, University of Waterloo, Ontario, Canada, 2004
Affiliations
Society of Actuaries Health Section
Society of Actuaries Social Insurance & Public Finance Section
12 April 2024 - by Zachary Fohl, Dean Johnson, Nick Gipe, Annie P Hallum, Jessica Bertolo, Marlene Howard, Nicholas Johnson
We provide an overview of the complexities surrounding the intersection of Medicare and Medicaid, and explore opportunities to better serve dual-eligible beneficiaries.
03 January 2019 - by Brad Armstrong, Marlene Howard, Christopher Pettit
The Centers for Medicare and Medicaid Services released proposed updates to Medicaid managed care regulations with the goal of easing some of the regulatory burdens while increasing the requirement for transparency.
12 September 2016 - by Brad Armstrong, Marlene Howard, Christopher Pettit
This paper provides a summary of the final Medicaid managed care rule’s significant impacts on the development of actuarially sound capitation rates and required supporting documentation.
Many aspects of the Affordable Care Act (ACA) provide additional opportunities for eligibility and benefit changes that would interest key stakeholders and warrant consideration in actuarial budget forecasts.
