A multi-state Medicaid MCO faced inconsistent pricing methodology across 7 state markets, with documentation gaps that had triggered state DOI questions in three of those jurisdictions. Lepton was engaged to rebuild the pricing framework from first principles — a unified methodology document, jurisdiction-specific calibration modules, and an audit trail covering every assumption. Outcome: Projected $42M in premium savings over three rate cycles and zero DOI methodology questions in the subsequent filing season.
Case Study · Actuarial Solutions
Rebuilding a Medicaid Pricing Framework from First Principles
A multi-state Medicaid managed-care organization needed pricing methodology that could withstand state DOI review across 7 jurisdictions. We rebuilt the framework end-to-end.
Lepton Engagement Team
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September 30, 2025
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Case study