Medicaid Programs

Medicaid programs are under more pressure than ever. States must demonstrate that their programs protect access, ensure quality and maintain timeliness of care — while serving populations with the most complex health and social needs, as federal oversight intensifies, managed care requirements evolve and the margin for error on program integrity, prior authorization and care coordination shrinks. Comagine Health® has worked inside Medicaid systems for more than 40 years, as both an independent evaluator and a hands-on implementation partner.

We are one of a small number of qualified External Quality Review Organizations nationally, with NCQA HEDIS certification and active contracts spanning external quality review, prior authorization validation, care management auditing, surveys and policy studies across multiple states. That combination of independent evaluation expertise and direct program delivery experience gives us a full view of how Medicaid programs function — and where they need to improve.

How We Help

Strengthening Medicaid systems through data, care and accountability

Medicaid work rewards partners who know the program from both sides. Because we evaluate managed care independently and deliver programs directly, we know where compliance gaps actually come from, which fixes hold up in operations and what oversight findings mean on the ground. That full view — evaluator’s rigor, implementer’s realism — is what we bring whether the engagement is an audit, a program or both.

Reviewing managed care performance independently

Assess managed care plan performance beyond basic compliance, through HEDIS® audits, survey administration, network adequacy validation and focused studies — surfacing the gaps that matter for access, quality and outcomes.

Auditing prior authorization and care management

Validate prior authorization and care management decisions through clinical record review, not just claims data, giving states defensible evidence to hold managed care plans accountable.

Helping members navigate fragmented systems

Help individuals with complex needs navigate fragmented systems by coordinating services, addressing barriers and improving continuity of care.

Supporting evidence-based care decisions

Support appropriate, evidence-based care decisions that balance access, quality and responsible stewardship of Medicaid resources.

Selected Work

Recent engagements

Helping Missouri hold Medicaid managed care accountable

As Missouri weighs extending its Medicaid managed care contracts through fiscal year 2028 amid its tightest budget years in a decade, the question of whether private insurers deliver enough value to justify the cost is under public debate. Comagine provides independent evaluation of Missouri’s Medicaid managed care plans, verifying that the roughly one million Missourians enrolled receive accessible, timely and quality care and giving the state objective evidence to hold insurers accountable as budget pressure mounts.

Strengthening rural care coordination and system alignment

Through the Alaska Medicaid Coordinated Care Initiative, we provide in-person, one-on-one case management for members with high emergency room use, helping them navigate the health system and access the care they need.

Providing quality improvement technical assistance to hospials, clinics and nursing homes

Working alongside Medicare-certified health care facilities managed by the Indian Health Service, tribes and Urban Indian Organizations, we support new or ongoing efforts that improve quality of care and patient outcomes through the Centers for Medicare & Medicaid Services AIAN QIO.

Improving quality and safety of resident care in nursing homes

The D.C. Medicaid Nursing Facility Quality Improvement Collaborative is a 5-year initiative to improve quality and safety of resident care in 15 nursing homes in and around the District of Columbia through system-level improvement activities.