Medicaid & Medicare
Partnering with agencies to serve the most vulnerable populations.
Our team of Medicaid and Medicare experts helps state agencies navigate the complexities of policy, funding, and program administration to drive better health outcomes and operational efficiency. With deep expertise across multiple Medicaid and Medicare domains, we provide strategic guidance to ensure compliance with evolving federal and state regulations, while maximizing funding opportunities. With more than six decades of healthcare experience, HORNE has a proven track record of designing and implementing programs that improve access and care for vulnerable populations.
Helping you give shape to sustainable, high-impact Medicaid & Medicare programs
From serving as an External Quality Review Organization (EQRO) to advising on care models and cost reporting, our team delivers tailored solutions that strengthen program integrity and financial sustainability.
Our Medicaid & Medicare Solutions:
Medicaid Policy
We help you navigate complex Medicaid regulations to maintain compliance and maximize funding opportunities, and provide added insights on federal policy changes and their potential impact on state Medicaid programs.
Medicaid Finance and Inter-Agency Funding
We assess and implement federal financing mechanism utilizing Certified Public Expenditures (CPE), Intergovernmental Transfers (IGTs), and Provider Taxes. Additionally, we design and administer inter-agency Medicaid programs, ensuring effective collaboration across stakeholder groups.
School-Based Medicaid Services
We work with you to develop strategies for effective programs that improve student health outcomes by strengthening the collaboration between schools and Medicaid services.
Value-Based Care
Together, we can enhance care quality and cost efficiency by designing and implementing value-based care models and supporting the transition to value-based payments.
Cost Reporting and Reimbursement
Ensure accuracy and compliance. Improve cost reporting processes. Maximize funding and reimbursement. Support provider reporting oversight. HORNE helps you do it all.
Managed Care Organization Oversight
With HORNE, you can ensure the compliance and integrity of your MCO programs by strengthening MCO oversight and monitoring.
1115 Waiver Support
Our team helps you design, develop and manage 1115 waivers, and evaluate whether your waiver programs are achieving your desired health outcomes.
LTSS and Self-Directed Care
Develop, manage and support Long-Term Services and Supports (LTSS) programs and self-directed care initiatives that empower beneficiaries and enhance quality.
Rural and Community Health
We help you address the challenges faced by rural and community health providers by developing tailored strategies geared to the specific needs of underserved areas.
Grant Management and Subrecipient Monitoring
Maximize grand and funding opportunities with effective grant management, streamlined processes and improved subrecipient monitoring.
Eligibility Determination and Support Services
By streamlining program eligibility processes and fine-tuning eligibility determinations, HORNE helps you ensure appropriate coverage and impact.
Behavioral Health
By promoting the integration of behavioral and physical health services, we help you improve access to care for those struggling with mental and substance use issues.
Maternal and Infant Health
Develop initiatives to improve maternal health outcomes and address disparities in care. Enhance care coordination and access to comprehensive maternal health services.
