Empowering Medicaid Leaders: Innovative Solutions for Today’s Challenges
State Medicaid programs face complex and unprecedented challenges – balancing shifting federal policies and rising affordability pressures with the urgent demand for care system transformation.
Faulkner Consulting Group partners with Medicaid leaders to develop practical, data-driven strategies that address today’s most urgent priorities. Let us help your team prepare for what’s next:
Let’s Work Together
Our team brings decades of experience helping Medicaid agencies solve complex problems —combining policy expertise, financial modeling, and operational know-how. Whether your state is redesigning care systems, modernizing payment models, or evaluating new federal opportunities, we help you move from vision to measurable impact.
Contact Us at info@faulknerconsultinggroup.com to learn how we can support you.
Transforming Access to Care in Rural Communities
Challenge: Rural hospitals and providers are struggling with financial pressure and workforce shortages, which threaten access to essential care.
How We Help: We help states design and implement rural health transformation strategies to stabilize hospitals, redesign provider networks, and align with initiatives like AHEAD to strengthen community health and long-term access to care. For more than a decade, we have established a proven track record of supporting states manage their federally funded, multi-million dollar grant programs to maximize impact.
Navigating Duals Program Changes
Challenge: CMS’s evolving approach to dually eligible populations requires new strategies for oversight, financing, and managed care alignment.
How We Help: We have direct experience helping states implement and optimize integrated dual eligible special needs plan (D-SNP) models. We assess financial impacts, evaluate integration options, and design coordinated care solutions. We also strengthen contracting and oversight mechanisms to improve member outcomes and ensure federal compliance.
Crafting a Strategic Plan for the Future that Drives Impact
Challenge: Creating a clear direction for Medicaid programs is challenging amid competing priorities, complex initiatives, and ongoing change.
How We Help: We support state leaders in developing a clear vision for the future, aligning teams around shared goals, and translating strategy into operational steps that drive lasting impact.
Keeping Care Affordable for Residents and Budgets
Challenge: Affordability pressures are driving states to explore new solutions, from reinsurance programs to provider affordability initiatives.
How We Help: We help states design and evaluate affordability programs that stabilize markets, maintain and expand coverage, and support budget predictability, using financial modeling and stakeholder engagement to ensure sustainability.
Maximizing Federal Funding through Cost Allocation
Challenge: Managing multiple funding streams and administrative claiming requirements can strain Medicaid agency capacity. State budgets are tightening as federal changes require significant technical implementation, while the federal match for SNAP administrative expenses is reducing by half next fiscal year.
How We Help: We work with states to evaluate current cost allocation strategies and assess opportunities to optimize funding, including identifying adjustments that maximize federal match and improve budgeting predictability. We can support states by determining the need for a CAM toolkit methodology, applying the most appropriate CAM approaches in alignment with federal guidance, testing allocation results for accuracy and compliance, and recommending final methodologies that meet federal claiming requirements.
Improving Maternal Health and Reducing Disparities
Challenge: Poor and inequitable maternal and infant health outcomes among Medicaid members.
How We Help: We support states in extending postpartum coverage, strengthening care continuity for mothers and infants, and implementing quality initiatives that improve outcomes and close disparities. We have extensive experience with maternity bundled payment models, including engaging stakeholders, designing technical specifications, managing the CMS review process, and developing reporting requirements and performance metrics.
Building a Stronger Continuum of Care for Children’s Behavioral Health Services
Challenge: States must increase capacity to meet growing demand for children’s behavioral health services.
How We Help: We partner with states to design and expand coordinated children’s service arrays that span prevention, crisis response, and stabilization – while aligning payment, data, and accountability structures. Working directly for state child welfare agencies, we support financial planning and budgeting, as well as program and technical implementations, including provider rate standardization and direct Medicaid billing.
Leveraging the AHEAD Model for Sustainable Transformation
Challenge: The CMS AHEAD model offers transformative potential but requires complex alignment across payers, providers, and state agencies.
How We Help: We help states assess readiness, align AHEAD goals with existing initiatives, and develop the financial and operational strategies needed to deliver sustainable, system-wide transformation.
Expanding Access to Behavioral Health Services
Challenge: Fragmented care delivery results in inefficiency and poorer outcomes for members with complex needs.
How We Help: We analyze system gaps, design integrated payment and delivery models, and implement performance frameworks that support whole-person care. We have deep expertise in the Certified Community Behavioral Health Clinic (CCBHC) model, including applying PPS methodologies, certifying and readying providers, and ensuring robust data reporting and oversight.
Managing Coverage Transitions Without Coverage Loss
Challenge: Large-scale coverage transitions, including the unwinding of the continuous coverage requirement and other new eligibility policies, create complex operational and communication challenges.
How We Help: We help states implement model enrollment strategies, analyze fiscal impacts, streamline renewal processes, and develop communication/outreach strategies designed to minimize coverage gaps.