Toney HealthCare Helps Health Insurers Support Massive Medicaid Growth in Wake of COVID-19 Pandemic

Clinical resources and consulting services support Medicaid insurers in serving their members as unemployment drives higher Medicaid enrollment.

TAMPA, Fla., May 4, 2020 /PRNewswire/ — The numbers are staggering.  As the unemployment rate soars due to the COVID-19 pandemic and economic downturn, and workers lose their employer-sponsored health insurance, experts predict that enrollment in Medicaid could increase dramatically.  Some estimates range from 11 to 23 million new enrollees in Medicaid over the next several months.1  As Medicaid managed care organizations face significant increases in membership, additional resources will be needed to serve these individuals and families.  In light of this, Toney HealthCare Consulting (THCC), a leading advisory firm for health plans and other risk-bearing entities, is providing expertise and clinical support for these organizations.

With a team of over 250 experts and experienced clinicians, THCC rapidly deploys to health plans across the country on an interim basis or for longer periods of time.  As health plans experience sudden increases in their member rolls, they may find themselves shorthanded in the doctors, nurses and other clinicians who help individuals with care authorizations, coordination of care across providers, and assistance in navigating the healthcare system.  THCC’s clinical resources include medical doctors and nurses as well as psychiatrists, psychiatric nurses and other behavioral health clinicians, such as clinical social workers and therapists.  In a time when social isolation and mental and emotional well-being are critical health factors, Toney HealthCare can support health plan members’ physical and behavioral health needs.

While supporting the needs of health plan members, THCC advisors provide leadership and guidance on best practices in clinical operations, quality and regulatory compliance, and help health plans determine the best course of action to serve their members during these challenging times.

“We have been partnering with health plans for over twelve years and stand ready to support them and their members now for as long or short as needed,” said Sam Toney, M.D., CEO of Toney HealthCare.  “Having served extensively in managed care organizations, our team has an in-depth understanding of how these plans work, especially Medicaid plans.  In areas where it is particularly difficult to find, hire and onboard staff, we can quickly plug in with appropriately licensed clinicians and expert advisors to provide leadership and front-line operations to serve individuals and families covered by the health plan.”

THCC’s Interim Staffing is a short-term solution to provide leadership, management and operational support of essential health plan functions such as Utilization Management, Case Management, Quality Assurance, Accreditation, Compliance and C-suite level leadership.  THCC professionals may be deployed individually or as teams to fill specific gaps in a health plan’s operations.

In contrast, THCC’s Insource Partnership is a long-term solution for health plans that need a full team to assume responsibility for a specific healthcare service, such as Case Management for a Medicaid expansion.  An expert THCC unit rapidly deploys and operates within the policies, procedures and systems of the health plan for an extended period.

THCC tailors solutions to the needs of each health plan and, in addition to Medicaid, also serves Medicare Advantage and Commercial populations.

About Toney HealthCare Consulting

Headquartered in Tampa, Florida, Toney HealthCare Consulting (THCC) provides advisory services, hands-on leadership and experts in clinical operations, quality, regulatory and compliance, and accreditation for health plans and other risk-bearing organizations nationwide.  Our team consists of over 250 subject matter experts, experienced clinicians and administrative professionals across the spectrum of healthcare services.  THCC has been a trusted advisor delivering customized solutions to clients since its founding in 2008.  For more information, visit

Media Contact:
Mike Miniati
Senior Vice President, Sales & Marketing
Toney HealthCare Consulting