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Welcome to
The Menges Group

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

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.

Learn More About This Service

Our Team

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Joel Menges

Chief Executive Officer
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Amira Mouna

Founding Partner
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Poornima Singh

Founding Partner
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Jessica Wiecezak

Founding Partner
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Richael OHagan

Director
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Charles Townley

Director
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Taryn Nader

Managing Consultant
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Veronica Sever

Managing Consultant
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Grace Williams

Managing Consultant
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Christie Ahn

Senior Consultant
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Emalee Barto

Senior Consultant
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Manisha Gupta

Senior Consultant
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Kyra Henderson

Senior Consultant
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Hannah Jin

Consultant
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Anastasia Johnson

Consultant
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Clarissa Moore

Consultant
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Courtney Pfeifer

Consultant
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Madeline Sale

Consultant
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Haley Quinn

Research Consultant
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Danielle Shapero

Research Consultant
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Phyllis Call

Office Administrator
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5-Slide Series

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

MCO Financial Performance During COVID

This edition looks at the collective financial performance of a large group of MCOs across the 2018-2021 timeframe. Our key findings are that the health plans performed quite well during the COVID-impacted years of 2020 and 2021 – better than they had performed during the pre-COVID years of 2018 and…
Read more Volume 107

Stock Prices During COVID

This edition presents the progression of large publicly traded health companies’ stock prices from January 1, 2019 through July 1, 2022. Our key purpose was to summarize stock prices through the COVID pandemic relative to the year before the pandemic began. While the pandemic has been devastating…
Read more Volume 106

Trends in Medicaid’s Average Costs Per Prescription

This edition presents our tabulations of Medicaid pharmacy cost and price trends. Some of our key findings: Nationwide Medicaid pre-rebate costs per prescription increased at an annual average rate of 5.6% from 2012-2021, led by an 11.9% annual rate of increase for brand drugs. Average costs per brand drugs rose…
Read more Volume 105

Medicaid Pharmacy Usage During COVID

This edition quantifies the decrease in Medicaid prescription volume that has occurred during COVID, comparing usage during calendar years 2019, 2020, and 2021. The large decrease that has occurred – 16.4% from 2019 to 2021 on a per covered person basis — is highly concerning regarding its implications…
Read more Volume 105

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

We were enlisted by the Anthem Public Policy Institute to assess the cost-effectiveness of different states’ approaches to managing Medicaid prescription drug benefit.  States were grouped into five cohorts depending on the degree to which their Medicaid prescriptions are paid for by MCOs or via the fee-for-service (FFS) setting…
Read more Volume 104
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Recent Publications

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…
Read more
Keywords: , ,

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…
Read more
Keywords: ,

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….
Read more
Keywords: ,

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….
Read more
Keywords: , ,

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….
Read more
Keywords: , ,

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…
Read more
Keywords: , ,

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…
Read more
Keywords: ,

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….
Read more
Keywords: ,

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…
Read more
Keywords: ,

Assessment of Report on Impacts of West Virginia Medicaid Prescription Drug Carve-Out

America’s Health Insurance Plans (AHIP) engaged The Menges Group to assess West Virginia’s Medicaid pharmacy carve-out impacts, analyzing the findings of another consulting firm’s report. Our analyses suggest that West Virginia’s carve-out has created increased Medicaid expenditures rather than savings. We also provide a large volume of…
Read more
Keywords: , ,

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…
Read more
Keywords: , ,

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…
Read more
Keywords: ,

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….
Read more
Keywords: ,

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….
Read more
Keywords: , ,

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….
Read more
Keywords: , ,

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…
Read more
Keywords: , ,

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…
Read more
Keywords: ,

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….
Read more
Keywords: ,

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…
Read more
Keywords: ,

Assessment of Report on Impacts of West Virginia Medicaid Prescription Drug Carve-Out

America’s Health Insurance Plans (AHIP) engaged The Menges Group to assess West Virginia’s Medicaid pharmacy carve-out impacts, analyzing the findings of another consulting firm’s report. Our analyses suggest that West Virginia’s carve-out has created increased Medicaid expenditures rather than savings. We also provide a large volume of…
Read more
Keywords: , ,
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