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Medicaid has surpassed both employer-based programs and Medicare to become the largest health insurance program in the U.S. today, covering over 68 million Americans. With the implementation of The Affordable Care Act (ACA), Medicaid has and will continue to expand to cover millions of previously uninsured adults, children, seniors and individuals with disabilities.

Additionally, the Center for Medicare and Medicaid Services has issued regulations for home and community based settings that will impact state Medicaid offices.

As part of this expansion and new regulatory environment, state spending on Medicaid
services rose by 8.1% in 2013 and is expected to have increased 2.7% in 2014.
Driven by increased state and Federal spending under the ACA, the National Association
of State Budget Officers estimated Medicaid spending to account for 25.8% of total
state spending in 2014.
As a result of this expansion and other ACA-related pressures, leaders of state
Human Services departments face increasing fiscal pressures and must understand
and navigate through a web of regulatory, programmatic, advocacy, provider and
legislative issues in order to address their program’s financial challenges.
Alvarez & Marsal’s (A&M) proven public sector experience enables leadership to
address these challenges. We provide both the analytical capabilities and political
expertise necessary to successfully implement effective financial solutions across a
complex community of stakeholders. Our professionals have expertise in dual eligible
populations, specializing in evaluating demand for services, provider assessments and
emerging models of care delivery. We have worked with secretaries, deputies, chiefs
of staff, and chief financial and budget officers of state Human Services departments,
as well as actuaries and chief operations officers on the state and county levels, in
order to meet the challenges of the current Medicaid budgetary environment.

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