Michael’s career as a healthcare actuary started in 2000. His area of expertise is managed healthcare programs, including Medicaid and Medicare Advantage (Parts A/B and D). He has advised state and federal government agencies, as well as private insurers. Michael has worked with public programs across the nation for the majority of his career in a variety of capacities. He has worked with clients to:
Develop and certify managed care rate ranges or upper payment limits for physical health, behavioral health, PACE, home and community-based services, foster care case management, and non-emergency transportation programs.
Establish strategy around program design, rate negotiations, and contracting strategy.
Develop FFS rates for behavioral health and home- and community-based services.
Develop project Medicaid agency-wide budgets.
Complete waiver-related cost effectiveness and other financial analyses.
Evaluate Medicaid managed care rates and provide negotiation support for Medicaid health plans and associations.
Prepare Medicare Advantage Part A/B and Part D bids and respond to desk review and audit requests.
Michael advises a wide range of clients on public programs, including the following:
Served as the certifying actuary for Medicaid managed care programs in eight states.
Assisted health plans in evaluating Medicaid managed care rates in several other states.
Advised the Medicare-Medicaid Coordination Office in rate development and structure for the Financial Alignment Initiative (a.k.a. “Dual” Demonstration).
Professional Designations
Fellow, Society of Actuaries
Member, American Academy of Actuaries
Education
BA, Mathematics, St. Olaf College, Northfield, Minnesota
08 April 2020 - by Katherine Wentworth, Carol H. Steckel, Jeremy Hoffman, Michael Cook, Greg J. Herrle
The COVID-19 pandemic is placing historic pressures on our healthcare system and coverage programs alike, and Medicaid programs are a key mechanism states are using to address these challenges.
While the planning, development, and implementation needs of a functional-based risk adjustment mechanism are significant, the improvements realized in Medicaid Managed Long Term Services and Supports programs are worth the effort.
As the number of Medicaid Managed Long Term Services and Supports (MLTSS) programs increases, there is also increased realization of the value of functional-based risk adjustment (FBRA) of managed care organization (MCO) capitation.
