Medicaid Programs
Medicaid programs are under more pressure than ever. States must demonstrate that their programs protect access, ensure quality and maintain fiscal accountability — 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
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Closing clinical and social care gaps for high-risk pregnancies
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Related Practices
Explore the practices behind this work
Let’s strengthen Medicaid systems together.
Ready to strengthen oversight, accountability and outcomes across your Medicaid program?