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Our projects support the evolution of coordinated care programs that improve the quality of life and lower expenditures for high-need Medicaid and Medicare beneficiaries.

What We Do

Business Development Strategy and Proposal Support
Data Analytics and Products
Operational Support for Managed Care Optimization
Public Policy Analyses

Business Development Strategy and Proposal Support

The Menges Group helps our clients win state Medicaid procurements, meaning we help our clients exist. We assist with several procurements annually, and the majority of our clients not only earn a contract award, they score first or second.

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Our Team

Joel Menges

Chief Executive Officer

Amira Mouna

Founding Partner

Poornima Singh

Founding Partner

Jessica Wiecezak

Founding Partner

Taryn Nader

Director

Richael OHagan

Director

Charles Townley

Director

Veronica Sever

Managing Consultant

Grace Williams

Managing Consultant

Christie Ahn

Senior Consultant

Emalee Barto

Senior Consultant

Manisha Gupta

Senior Consultant

Kyra Henderson

Senior Consultant

Hannah Jin

Consultant

Anastasia Johnson

Consultant

Clarissa Moore

Consultant

Courtney Pfeifer

Consultant

Madeline Sale

Consultant

Haley Quinn

Research Consultant

Danielle Shapero

Research Consultant

Mint Dalton

Summer Associate

Caitlin Otter

Summer Associate

Phyllis Call

Office Administrator

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5-Slide Series

Medicaid Prescription Drug Trends

This edition summarizes our tabulations of several key Medicaid prescription drug cost and usage trends across the 2018-2022 timeframe. Our findings include: • Pre-rebate costs per Medicaid prescription grew sharply, at an average annual rate of 9.7% from 2018-2022. • Prescriptions per Medicaid enrollee have trended steadily downward since the onset…

Read more Volume 117

Medicaid Redeterminations

This edition conveys some of our perspectives related to the current reinstatement of Medicaid redeterminations. This is an important time period to capture (and share) detailed information on how Medicaid enrollees can best be successfully reached, as well as the dynamics of continuous enrollment, coverage retention and loss….

Read more Volume 116

Medicaid Enrollment Trends

This edition focuses on the share of the overall population that receives Medicaid, and how this percentage has trended throughout the past decade nationally and state by state. Between Medicaid expansion, COVID dynamics, and some shifts in the economy’s performance, the past ten years have created several interesting…

Read more Volume 115

Medicaid Postpartum Coverage Extension: A Review of Coverage by State and Postpartum Healthcare Utilization

This edition looks at state implementation of Medicaid postpartum coverage extension and Medicaid expansion by state. We also present rates of postpartum care utilization in the Medicaid population before and after implementation of postpartum coverage extension. As of March 2023, 45 states and D.C. have implemented Medicaid expansion…

Read more Volume 114

Addressing Gaps in Behavioral Health Treatment and Medication Use

This edition explores ways to make optimal use of available resources to help fill the extensive gaps in behavioral health care (BH) that exist in the US.

Read more Volume 113

Medicare Special Needs Plan (SNP) Program Trends

The information tabulated and presented shows the progression of Medicare Special Needs Plan (SNP) health plan participation and SNP enrollment across the past decade – looking specifically at January of 2013, 2018, and 2023. By just about every measure, the SNP program has achieved tremendous growth.

Read more Volume 112

Assessment of Medicaid Expenditure and Capitation Trends From 2011-2021

This edition looks at state-level and national Medicaid spending trends, first overall and then by the share of Medicaid spending that is paid via capitation.

Read more Volume 111

Recent Death Trends by State, Grouped by Governor’s Political Party

This edition conveys tabulations on overall death rates and COVID death rates by state, including grouping states by the Governor’s political party.

Read more Volume 110

COVID-19 Deaths Across Time: Comparison of US Deaths in 2022 with Previous Years, by Age and Race Cohort

This edition looks at the progression of COVID deaths and death rates by year in different cohorts (e.g., age and race/ethnicity).

Read more Volume 109

Trends in Medicaid Use of Capitation

This edition looks at the progression of capitation contracting in the Medicaid program at the national and state levels. As s a percentage of total Medicaid spending, capitation contracting has grown 31.1% in FFY2013 to 55.9% in FFY2021. National Medicaid spending via capitation was 47% larger than fee-for-service…

Read more Volume 108

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Recent Publications

Medication Adherence in Medicaid

Building upon our 2014 report titled Prescription Drug Adherence in Medicaid Managed Care, this report provides updated analyses performed on medication adherence, assesses the impacts of Medicaid expansion and the COVID-19 pandemic on medication adherence, and offers recommendations for further improvement to Medicaid medication access and adherence.

Keywords: COVID-19, Medicaid, Policy, Prescription Drugs

Medicaid Prescription Drug Benefit Management: Performance Comparison Across Different State Policy Approaches

States that employ Medicaid managed care organizations (MCOs) to pay for prescription drugs outperform states that rely on the fee-for-service (FFS) setting to control drug costs. Despite larger rebates in FFS, MCOs’ effective strategies to encourage…

Keywords: Expenditures, Medicaid, Prescription Drugs

Assessment of Kentucky’s Medicaid Managed Care Program Impacts

The purpose of this study is to assess the impacts of Kentucky’s Medicaid managed care program. The key components of this assessment include: • Cost impacts of the Medicaid managed care program across the past two decades • Performance on key quality measures • Opioid and medication-assisted treatment (MAT) prescription drug usage trends • Kentucky’s recent experience…

Keywords: Medicaid, Policy

Assessment of Medicaid Expansion Impacts

The purpose of this study is to compare the US states that have adopted the Affordable Care Act’s (ACA) Medicaid Expansion to the states that have not done so. The Medicaid Expansion makes people with incomes up to 138 percent of the federal poverty (FPL) line eligible for Medicaid….

Keywords: Expansion, Medicaid

Assessment of New Jersey’s Medicaid Prescription Drug Management Performance and Policy Options

The New Jersey Association of Health Plans enlisted the Menges Group to evaluate New Jersey’s Medicaid prescription drug costs and assess the potential impacts of a pharmacy carve-out approach, whereby the prescription drug benefit would be removed from the MCOs’ responsibility and paid for in the fee-for-service (FFS) setting….

Keywords: Pharmacy Carve Out, Policy, Prescription Drugs

Assessment of Common Core Formulary Impacts on Virginia Medicaid Managed Care Drug Spending

Virginia began implementing a Common Core Formulary within its Medicaid managed care program in 2017 for CCC Plus members and in 2018 for Medallion 4.0 members. The Virginia Association of Health Plans (VAHP) engaged The Menges Group to analyze the fiscal and programmatic impacts of this policy change….

Keywords: Expenditures, Medicaid, Prescription Drugs

Assessment of Virginia Medicaid Pharmacy Benefits Carve-Out Impacts

Some Virginia policymakers have indicated an interest in moving to a pharmacy “carve-out” within the Medicaid managed care program, whereby the state would instead manage the pharmacy benefit for MCO enrollees, including paying directly for drugs made available in the program. Virginia’s Association of Health Plans engaged The Menges…

Keywords: Medicaid, Pharmacy Carve Out, Policy

Value of Managed Care Organizations and Pharmacy Benefit Managers in Managing the Medicaid Prescription Drug Benefit

PCMA engaged The Menges Group to estimate the financial and programmatic value of managing the prescription drug benefit in the Medicaid managed care setting, comparing states that utilize MCOs – who contract with PBMs – for their prescription drug benefits to states that manage their prescription drug benefits in…

Keywords: Medicaid, Prescription Drugs

Assessment of Medi-Cal Pharmacy Benefits Policy Options

Policymakers are considering moving Medi-Cal to a pharmacy “carve-out” – that is, shifting the pharmacy benefit out of managed care to instead be administered by the state in fee-for-service (FFS). The carve-out proposal is motivated, in part, by the potential for the state to collect more drug manufacturer rebates….

Keywords: Pharmacy Carve Out, Policy

Assessment of Pennsylvania’s Medicaid Preferred Drug List Policy Options

The Pennsylvania Coalition of Medical Assistance MCOs engaged The Menges Group to estimate the fiscal impacts of switching to a uniform PDL in Pennsylvania and to assess the programmatic advantages and disadvantages of this policy change. Our analyses indicate that the Commonwealth of Pennsylvania and its taxpayers would incur…

Keywords: Policy, Prescription Drugs

Medication Adherence in Medicaid

Building upon our 2014 report titled Prescription Drug Adherence in Medicaid Managed Care, this report provides updated analyses performed on medication adherence, assesses the impacts of Medicaid expansion and the COVID-19 pandemic on medication adherence, and offers recommendations for further improvement to Medicaid medication access and adherence.

Keywords: COVID-19, Medicaid, Policy, Prescription Drugs

Medicaid Prescription Drug Benefit Management: Performance Comparison Across Different State Policy Approaches

States that employ Medicaid managed care organizations (MCOs) to pay for prescription drugs outperform states that rely on the fee-for-service (FFS) setting to control drug costs. Despite larger rebates in FFS, MCOs’ effective strategies to encourage…

Keywords: Expenditures, Medicaid, Prescription Drugs

Assessment of Kentucky’s Medicaid Managed Care Program Impacts

The purpose of this study is to assess the impacts of Kentucky’s Medicaid managed care program. The key components of this assessment include: • Cost impacts of the Medicaid managed care program across the past two decades • Performance on key quality measures • Opioid and medication-assisted treatment (MAT) prescription drug usage trends • Kentucky’s recent experience…

Keywords: Medicaid, Policy

Assessment of Medicaid Expansion Impacts

The purpose of this study is to compare the US states that have adopted the Affordable Care Act’s (ACA) Medicaid Expansion to the states that have not done so. The Medicaid Expansion makes people with incomes up to 138 percent of the federal poverty (FPL) line eligible for Medicaid….

Keywords: Expansion, Medicaid

Assessment of New Jersey’s Medicaid Prescription Drug Management Performance and Policy Options

The New Jersey Association of Health Plans enlisted the Menges Group to evaluate New Jersey’s Medicaid prescription drug costs and assess the potential impacts of a pharmacy carve-out approach, whereby the prescription drug benefit would be removed from the MCOs’ responsibility and paid for in the fee-for-service (FFS) setting….

Keywords: Pharmacy Carve Out, Policy, Prescription Drugs

Assessment of Common Core Formulary Impacts on Virginia Medicaid Managed Care Drug Spending

Virginia began implementing a Common Core Formulary within its Medicaid managed care program in 2017 for CCC Plus members and in 2018 for Medallion 4.0 members. The Virginia Association of Health Plans (VAHP) engaged The Menges Group to analyze the fiscal and programmatic impacts of this policy change….

Keywords: Expenditures, Medicaid, Prescription Drugs

Assessment of Virginia Medicaid Pharmacy Benefits Carve-Out Impacts

Some Virginia policymakers have indicated an interest in moving to a pharmacy “carve-out” within the Medicaid managed care program, whereby the state would instead manage the pharmacy benefit for MCO enrollees, including paying directly for drugs made available in the program. Virginia’s Association of Health Plans engaged The Menges…

Keywords: Medicaid, Pharmacy Carve Out, Policy

Value of Managed Care Organizations and Pharmacy Benefit Managers in Managing the Medicaid Prescription Drug Benefit

PCMA engaged The Menges Group to estimate the financial and programmatic value of managing the prescription drug benefit in the Medicaid managed care setting, comparing states that utilize MCOs – who contract with PBMs – for their prescription drug benefits to states that manage their prescription drug benefits in…

Keywords: Medicaid, Prescription Drugs

Assessment of Medi-Cal Pharmacy Benefits Policy Options

Policymakers are considering moving Medi-Cal to a pharmacy “carve-out” – that is, shifting the pharmacy benefit out of managed care to instead be administered by the state in fee-for-service (FFS). The carve-out proposal is motivated, in part, by the potential for the state to collect more drug manufacturer rebates….

Keywords: Pharmacy Carve Out, Policy

Assessment of Pennsylvania’s Medicaid Preferred Drug List Policy Options

The Pennsylvania Coalition of Medical Assistance MCOs engaged The Menges Group to estimate the fiscal impacts of switching to a uniform PDL in Pennsylvania and to assess the programmatic advantages and disadvantages of this policy change. Our analyses indicate that the Commonwealth of Pennsylvania and its taxpayers would incur…

Keywords: Policy, Prescription Drugs

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