Annie P Hallum

Annie has experience in providing actuarial support and consulting services to state Medicaid agencies, health plans, and providers in more than 10 states.

Annie's actuarial experience includes Medicaid rate setting, health policy and waiver support, Medicare Advantage premium rate development, Medicaid Managed Care procurement support, state budget projections, legislative impact analysis, and audit support.

Recent projects include:

• Medicaid rate setting for managed care programs covering physical health, behavioral health, and dental benefits for low-income family, blind and disabled, ACA adult expansion, foster care, and CHIP populations
• Long-term services and supports provider payment rate development and financial projections
• Development of upper payment limits and certification of Medicaid capitation rates for Programs of All-Inclusive Care for the Elderly (PACE)
• Support for 1915(b)/(c) and 1115 waiver design, application, and implementation
• Design and implementation of inpatient and outpatient Medicaid payments models using All Patients Refined Diagnosis Related Groups (APR-DRGs) inpatient payment rates and Enhanced Ambulatory Patient Groups (EAPGs)
• Medicaid Managed Care procurement support
• Analysis of state provider assessments and payments to hospitals and physician groups to promote Medicaid provider access
• Upper payment limit demonstrations for nursing home, inpatient, outpatient, professional, and clinic services
• Alternative payment model design, including bundled payment rates and hospital all-payer budgets
• Actuarial modeling of healthcare variables to test their impact of proposed changes to current and projected healthcare costs
• Development and analysis of changes to provider reimbursement