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Been there

Reston-based Maximus to guide states through phases of health-reform law

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Print this page by Robert Burke

For states struggling to figure out the requirements of the new federal health-care law, Reston-based Maximus will be happy to help.
The new Patient Protection and Affordable Care Act, signed into law in March, gives states until 2014 to establish exchanges where individuals and small businesses can buy health insurance. Maximus already does a lot of work in the field. About 70 percent of its revenues this year — estimated at $828 million to $838 million — will come from the health-care field.

Maximus has about 6,000 employees, including 500 at its Reston headquarters. It already helps 13 states handle the intricacies of Medicaid benefits. Company officials think it can gain some business by helping those states and others figure out how to adapt to the new health-care law.

Bruce Caswell, president and general manager of Maximus Health Services, is leading the effort. “We’re out talking with states about what types of models can be implemented to meet the requirements of the law as they’re currently known, given that we don’t have regulations,” he says.

Most states still are trying to figure out how temporary, high-risk insurance pools required by the law will work. States have the option of running their own high-risk pools or letting the federal government handle the task. (That is what Virginia decided to do.)  Maximus is reaping rewards in that sector, too —California in early August chose Maximus to handle the administration of its high-risk pool, which will cover up to 25,000 people.

Attention is turning slowly toward the insurance exchanges. Caswell says states “are like sponges right now, just sucking up information” on how to implement different parts of the law.

Maximus can call on its experience in helping Massachusetts set up its health-care coverage program, which was passed by the state legislature in 2006. In that instance, Caswell says, Maximus used its background in running Medicaid managed-care programs to help the state screen people for eligibility in the new program.

Understanding how Medicaid programs work now and how they’ll be expanded under the new law is essential, Caswell says.
About 47 million people in the U.S. are uninsured, and an estimated 32 million will be able to get health insurance under the new law. Of that total, 16 million will likely get it through existing state-operated Medicaid programs.

“We believe the [state] Medicaid agencies will have a big role,” Caswell says. “The big challenge is that people are going to traverse these boundaries” and move from Medicaid coverage to insurance purchased through the exchanges, or through employers. Children who are covered by the federal Children’s Health Insurance Program, known as CHIP, also will cross from one coverage option to another over time.
In addition to figuring out how the law will affect residents, states have to decide whether to run a bigger, more comprehensive health-care program as Massachusetts did, or a smaller version. “I think we’re kind of neutral, honestly,” Caswell says. “In our view, the fundamental functions are going to have to be provided regardless of what model you use.”


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