Senior Advisor on Medicaid

ORAU is seeking a Fully Remote, Senior Advisor on Medicaid to work with CMMI as an ORAU employee. This exciting work will last one or more years, and the successful candidate will become a temporary employee of ORAU assigned to the Centers for Medicare and Medicaid Services Innovation (CMMI). This position is 30- 40 hours per week.

CMMI was established by Congress in 2010 to identify ways to improve healthcare quality and reduce costs in the Medicare, Medicaid, and Children's Health Insurance (CHIP) programs. Following this charge, CMMI, through its models, initiatives and Congressionally-mandated demonstrations, has accelerated the shift from a health care system that pays for volume to one that pays for value. CMMI models are also researching and testing different approaches to innovative information technology systems which are essential to supporting this value transformation.

CMMI is seeking assistance in the design and support of current research and development activities related to healthcare delivery and payment reform, in support of Section 1115A(a)(3) of the Social Security Act. Specifically, for CMMI models focused on Medicaid populations, a subject matter expert with extensive expertise in Medicaid is needed to provide CMMI staff with consultative Medicaid policy expertise during new model design and launch during calendar year 2024. This subject matter expert will also assist CMMI leadership and teams as they develop strategies to achieve multi-payer
alignment between Medicaid and Medicare, and develop strategies for effective engagement of states in the CMS Innovation Center's newest models. Additionally, this subject matter expert will use their extensive Medicaid background and experience to assist CMMI SPHG leadership in collaborating-with the Center for Medicaid & CHIP to better identify and foster best practices for cross-component alignment.

This position will provide Medicaid finance and policy expertise during the pre-implementation period of the AHEAD Model. This is to include technical expertise and innovation in Medicaid finance, especially in the construction of Medicaid hospital global budgets (HGB) and treatment of supplemental payments; provide technical assistance to states on potential legal pathways to implement Medicaid HGBs and Medicaid advanced primary care (APC) payment and care delivery models; provide guidance to states on Medicaid considerations in the construction of state all-payer cost growth benchmarking. In addition, serves as a SME for the AHEAD Model team on Medicaid issues and reviews model policy and legal documents that pertain to Medicaid program requirements or policy.

In-depth knowledge of Medicaid programs, including delivery system reform, provider payment approaches, supplemental payments, access to care, and beneficiary experience.
• Expert knowledge of Medicaid 1115 demonstrations, especially pertaining to hospital and primary care payment and care delivery transformation.
• Expert knowledge of state-directed payment policy and Medicaid hospital financing including supplemental payments.
• Familiarity with Medicaid claims data and quality measures.
• Ability to work collaboratively with senior state officials and key Medicaid industry stakeholders including but not limited to CMS Center for Medicaid & CHIP Services, National Association of Medicaid Directors, Medicaid and CHIP Payment and Access Commission, etc.
• Ability to translate complex technical policy into plain language.
• Ability to work independently and plan tasks with only high-level guidance on objectives.

Deliverables:

• Identify technical assistance needs and for each AHEAD state.
• Provide ongoing TA to states that results in an approved Medicaid HGB methodology and implementation of HGBs in PY1, including advising on treatment of Medicaid supplemental payments.
• Provide ongoing TA to states that results in successful implementation of a Medicaid PCMH or other primary care APM in PY1.
  1. Participate in weekly calls with CMMI AHEAD Model team to provide expertise on Medicaid policy. Review and provide input on state-submitted proposals and requests.
  2. Participate in regular calls between CMMI and SMAs.
  3. Support CMMI AHEAD Model team in coordinating with CMCS.
  4. Participate in up to 6 site visits with SMAs.
     1. Two-night site visits to up to six AHEAD states to provide intensive technical assistance to SMAs on innovation in Medicaid finance, especially in the construction of Medicaid HGBs, potential legal pathways to implement Medicaid HGBs and Medicaid APC payment and care delivery models, and develop strategies for hospital recruitment. These activities will require in-person meetings with a variety of stakeholders, including SMA staff, hospitals, MCOs, and primary care providers.

• Master's or other graduate degree in social science, public health/medicine, public policy, or related field with 6-10 years experience in the Medicaid state agency field.
• Experience working in an executive level leadership role within a state Medicaid agency.
• Experience designing and/or implementing Medicaid Value Based Payment models.
• In-depth knowledge of Medicaid programs, including delivery system reform, provider payment approaches, access to care, and beneficiary experience.
• Familiarity with Medicaid claims data and reporting.