We help clients transform healthcare by solving complex problems.
Navigating Medicaid Community Engagement and Work Requirements
Challenge: Federal reforms now require many states to verify community engagement activities — work, education, or job training — before certain adults can qualify for Medicaid. Agencies must stand up new eligibility systems, verification workflows, member communications, and appeals processes on a tight timeline, while minimizing coverage loss for members who remain eligible.
How FCG Helps: FCG partners with state agencies to translate federal requirements into workable state policies, design eligibility and exemption criteria, build compliant verification and reporting processes, and develop communications strategies that reduce procedural disenrollment and maintain coverage.
Securing the Future of Rural Health Care
Challenge: States are leveraging Rural Health Transformation Program (RHTP) funding to strengthen rural hospitals, expand the health care workforce, and modernize technology in underserved areas. Health agencies must move quickly to execute approved plans while addressing underlying issues driving rural hospital closures and service reductions.
How FCG Helps: FCG helps states put approved RHTPs into action and track whether investments are improving access, workforce capacity, and provider sustainability. We support our clients with the program design, subrecipient oversight and monitoring, and reporting needed to maintain compliance, demonstrate progress, and maintain funding.
Driving Access and Innovation Through Health Insurance Marketplaces
Challenge: State-based insurance marketplaces must balance competing priorities – improving affordability, implementing new technologies, and responding to changing federal policies – while keeping operations running smoothly for enrollees, issuers, and agents.
How FCG Helps: More than a decade ago, our Founder, Deb Faulkner, and other FCG leaders built Rhode Island’s health insurance marketplace, HealthSource RI (HSRI), and FCG has maintained a dedicated on-site team ever since. Building on this experience, we help state-based marketplaces navigate policy and regulatory changes, analyze market trends, improve operations, integrate new technologies, and develop long-term strategies, including design and implementation of state-funded subsidy programs.
Transforming Behavioral Health Systems to Meet Rising Need
Challenge: Demand for mental health and substance use disorder services continues to grow among adults, youth, and children. Health agencies and providers need reliable data and a clear view of the behavioral health system to identify where there are gaps and where investments will have the greatest impact.
How FCG Helps: For Rhode Island, FCG conducted a statewide assessment of behavioral health service delivery, identified gaps, and developed priorities for action. We then supported statewide implementation of the Certified Community Behavioral Health Clinic (CCBHC) model and Mobile Response and Stabilization Services (MRSS) for children and youth. FCG has also supported states in building a stronger continuum of care for children’s behavioral health by expanding children’s services and aligning payment, data, and accountability structures.
Improving Health Outcomes through Value-Based Models
Challenge: Health care payers and providers are expected to control rising costs while improving quality of care and outcomes for the people their programs serve.
How FCG Helps: We help payers and providers design, implement, and evaluate value-based payment models that improve quality, strengthen accountability, and manage costs. Our work has included maternity bundled payment programs, value-based primary care, ACO and Accountable Entity arrangements, HCBS performance incentive models, and Medicare value-based payment programs.
Advancing Integrated Care for Older Adults and People with Disabilities
Challenge: Older adults and people with disabilities often rely on services funded through both Medicaid and Medicare. Supporting those populations involves navigating complex regulations, fragmented eligibility processes, and disconnected systems that make care difficult to access and coordinate.
How FCG Helps: FCG helps strengthen services to older adults and people with disabilities by streamlining LTSS eligibility and enrollment processes, improving access to home and community-based services (HCBS), and designing integrated models that better coordinate care and coverage across Medicaid and Medicare. Our team has also supported Medicare-Medicaid integration initiatives, including design and implementation of dual-eligible special needs plan (D-SNP) models.
Designing Health Systems to Meet Tomorrow’s Needs
Challenge: Health care organizations must continually assess whether the service mix, workforce capacity, delivery models, and provider networks are keeping pace with community needs, payment models, and market conditions.
How FCG Helps: FCG helps clients take a system level view to assess service delivery, identify gaps in access and capacity, and determine how providers, programs, and resources can be better aligned with community needs. We combine data analysis, stakeholder input, and policy and market expertise to develop practical recommendations for strengthening the health care delivery system.
Modernizing Medicaid Management Information Systems
Challenge: Many Medicaid agencies are still running eligibility, claims, and provider management through aging Medicaid Management Information Systems. These legacy platforms are costly to maintain, hard to adapt to new program requirements, and increasingly out of step with CMS’s modular, Medicaid Information Technology Architecture (MITA)-aligned certification standards. Replacing them module by module is a complex multi-year effort.
How FCG Helps: FCG supports states across the MMIS modernization lifecycle by shaping procurement strategy and request for proposal (RFP) requirements; supporting vendor selection and oversight; building business processes and test plans; and managing implementation across state program, IT, and vendor teams. Throughout the transition, we focus on maintaining operations and identifying and resolving issues before they result in disruptions in service.
