Health Policy and Program Design

The first step to health care reform is designing effective and thoughtful policies that are clearly focused on the goal of reform. The Center for Health Law and Economics at UMass Medical School works with public sector organizations to analyze the factors influencing the current system. Our staff can determine what is working and what can be improved.

Reform can address multiple factors at once, from changing eligibility rules and adjusting payment structures to securing new federal waivers. Whatever the methods, we make sure our recommended health care policy and program solutions are politically feasible, economically sound, and achievable within federal guidelines.

As part of the health care policy and program design process, the Center for Health Law and Economics at UMass Medical School provides the following:

  • Reviews of existing regulations, legislation, and programs
  • Recommendations for changes
  • Deep knowledge of Medicaid policy, which enables us to determine what is feasible
  • Analysis of spending activities for opportunities to leverage new funding
  • Examinations of provider and service capacities, delivery networks, and supply chains
  • Research on the best practices from other states for replication
  • Assessment of the political environment
  • Engagement with the community, trade associations, and advocates on behalf of reform


As states’ primary means for extending health care coverage to their most vulnerable residents, Medicaid and the Children’s Health Insurance Program (CHIP) often make up the foundation of state health reform initiatives. These complex programs, governed by overlapping layers of federal and state laws and regulations, can also bring federal financial resources to states. Our staff keeps up-to-date on the federal and state regulations and understands that every modification has the potential to affect new and existing health care policies and programs. As health lawyers, our team leaders have the necessary experience to anlayze and intrepret the statutory and regulatory provisions of Medicaid and CHIP and we assess the following for our clients:

  • The financial and coverage impacts of new or proposed Medicaid and CHIP rules on public programs or policies
  • Whether new policies or programs are in compliance with Medicaid and CHIP rules
  • The impact of related federal laws on existing Medicaid and CHIP programs
  • Role of Medicaid and CHIP in broader reform efforts

Further flexibility in Medicaid and CHIP is available through State Plan amendments and the federal waiver process. Our long experience conceiving and drafting State Plan amendments and federal waivers has educated us on their tremendous potential — and their pitfalls. This experience, along with our deep understanding of the legal and financial aspects of the waiver process, enables us to guide our clients through the process