Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: Social Insurance & Public Finance Section council members provide a recap of sessions from the 2021 SOA Health Meeting, with a focus on sessions covering Medicare, Medicaid, the ACA, and public policy. The authors include a description of SIPF Section-sponsored sections, including a session on the ACA and a session on CMS's Direct Contracting Model.

Description: COVID-19 is causing changes to nursing homes that will last beyond the pandemic. Nursing homes serve Medicare and Medicaid beneficiaries; so, in the public interest, we should consider how changes to nursing homes might impact these populations.

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: This article gives part of the testimony provided to a U.S. House Subcommittee about Medicaid abuse. Specifically, it explains how families with ample means are able to skirt the law and obtain Medicaid funding of nursing home care when private Long Term Care insurance should have been considered.

Description: The article describes the sessions that the SIPF section sponsored - Paid Family Leave and Medicare and Medicaid Update. The Paid Family Leave session described what it is and what states it is currently in and how it is being implemented. The Medicare and Medicaid update gave the attendees the most up to date news about what is going on at the Federal level.

Description: Coverage of Medicaid home and community-based services under the 1915(i) state plan option: Attractive features and important considerations

Description: This article discusses amendments to the Social Security Act recommended by President Johnson which are incorporated in H.R. 5710. The bill amends the provisions and of the OASDI, Medicare and Medicaid programs.

Description: Interview of people knowledgeable about risk adjustment and the use of social determinants of health with that context for Medicaid.