Resource Allocation and Eligibility Determination Development
We help states establish data-driven algorithms and person-centered processes to develop budgets that support equity and efficiency. We also assist in designing business processes that enhance the effectiveness of the proposed new algorithm, such as exception and material improvement processes and/or risk pooling mechanisms.
Our team is uniquely capable of doing this work, and HCBS Strategies brings
- Detailed knowledge of Medicaid and ACL regulatory requirements and review processes.
- Extensive experience developing and analyzing assessment data instruments.
- Deep understanding and experience developing acuity-based resource allocation systems (e.g., case mix), and an interRAI Fellow on staff who participates in the international research society devoted to building and testing tools to support HCBS program operations.
- Experience with large data sets and can develop modeling files that allow us to understand the implications of changes to eligibility or budgeting.
We also assist states in evaluating, defining, and refining eligibility criteria, such as criteria that determine whether level of care (LOC) is met for 1915(c) HCBS Waivers or Community First Choice, to ensure that programs are reaching the correct individuals that a state is intending to serve. Whether a state needs to ensure eligibility consistency while adopting a new assessment instrument or wants to better understand and consider revising their existing criteria, our team has extensive experience in guiding states through these types of projects.
In determining how to craft an eligibility or resource allocation algorithm, we typically take the following approach:
- Discuss the goals of the state and identify the circumstances leading to the need for change.
- Conduct a high-level review of program operations and data sources
- Craft an approach that reflects the needs and resources of the state
