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Medicaid is extremely complicated and you should focus your detailed study depending on the job’s focus (e.g., policy vs fiscal). Overall, though, you will need to focus on two basic things: 1) Medicaid is a state operated healthcare program for low income and aged, blind, disabled people (and others depending on state), funded partially with federal dollars (each state gets federal matching dollars based on trailing economic conditions), so each state’s program is different, and 2) CMS regulates the state programs through state plan amendments and waiver authorities (most commonly 1115 waivers).
So, read up on 1115 waiver basics and then choose a couple states to understand what they’re doing with their waivers. I recommend Georgia and New York. You’ll get a strong understanding just by reading publicly available info from those two.
I would utilize understanding the federal agency CMS - and understand where Medicaid sits within the agency. And get up to speed by understanding Medicaid broadly - then browsing into some of the waivers, etc. Not something you can do overnight so I would just focus on the high level stuff.
Tysm!
Good suggestions above. Definitely start there. To add a different lens, spend time understanding business models and services offered by companies like Centene that focus on Medicaid.
Coach
Medicaid is a dual payer construct- feds cover some and the overall benefit level and structure are determined by state. Therefore, what state Medicaid your employer is talking about will be critical; knowing a lot about CA Medicaid won’t necessarily help you for MA. Next, there are different eligibility populations . Most states cover moms and kids. Aged, disabled and blind have different coverage by state. Lastly, some are dual eligible (eligible for Medicare and Medicaid). Lastly, states vary greatly on how they allow managed care organizations to be subcontractors to the program. What state will you be working with? That’ll be the most critical question.
Kff.org
Check out their medicaid materials, they have info on state by state policies, 1115b waivers, enrollment, etc.
Mentor
I would recommend learning about how that particular state(s) handles things such as risk adjustment, enrollment, attribution, etc. This info will all be state by state, so your best place to learn this is probably the state bureau’s website.
What kind of company and what is the job title? The type of knowledge likely required varies significantly based on that.
Everyone was so helpful!