Andrew Gaffner

Andrew has assisted clients across the health insurance industry, specifically in the area of managed healthcare programs. He is at the forefront of innovative solutions for managed care programs in the Medicaid space, working directly with state government agencies and CMS for current issues. Some examples include:

• Serving as certifying rate setting actuary for Florida's Statewide Medicaid Managed Care (SMMC) program
• Assisting with implementation of a comprehensive value-based payment arrangement program within Medicaid
• Designing payment arrangements to consider the significant costs associated with breakthrough new gene therapy treatments
• Working with a state to negotiate with MCOs and ensure state goals will be appropriately implemented
• Creating a quality withhold program to advance the state’s goals of improving quality
• Valuing the impact of redeterminations on Medicaid capitation rates due to the end of the Public Health Emergency (PHE) and the resulting disenrollment
• Working with CMS in evaluating state capitation rates for the Dual Demonstration Program
• Designing risk mitigation models for new programs and new services covered within a Medicaid program
• Modeling provider reimbursement rates for services provided within Florida's SMMC program
• Analyzing the costs associated with lack of supports for various diverse populations
• Assisting with completing preprints and modeling payments for directed payments included in the Medicaid capitation rates

He has advised state government agencies, hospital systems, insurance companies, MCOs, and other healthcare clients. His experience with Medicaid coverage from the perspective of insurers, providers, and government stakeholders enables him to provide unique insight on a wide range of issues.