Program Design

Harbage Consulting has a long history of assisting state and local governments in designing new and reforming existing public health care programs. The program design services our firm offers include:

  • Strategic planning and advice
  • Program landscape reviews and gap analyses
  • Policy, financing, and operational recommendations
  • Implementation planning
  • Quality and performance measurement
  • Health care stakeholder engagement

Click on the projects below to learn more about our work.

Medicaid Substance Use Disorder 1115 Waiver Development

In 2017, Harbage Consulting provided policy and clinical expertise and strategic advice to the West Virginia Department of Health and Human Resources, the Alaska Department of Health and Social Services, and the Minnesota Department of Health Services in developing Medicaid section 1115 waiver proposals to provide a comprehensive set of services designed to treat and prevent substance use disorders (SUDs).


Specifically, we supported West Virginia and Alaska state leaders as they thought through the elements of the waiver design, determined the expanded set of benefits that would be provided under the waiver, determined the delivery system, and planned for recruiting and training of SUD providers to ensure the states has a strong network of support and treatment options. West Virginia’s waiver was approved in October 2017 and Alaska’s waiver, which includes the SUD service expansion as one component, is pending with the Centers for Medicare & Medicaid Services.


For more information on our work in this area, see our Case Study.

Virginia Medicaid Eligibility Performance

The Virginia Department of Medical Assistance Services (DMAS) contracted with Harbage Consulting to conduct a strategic planning activity designed to increase accountability for the state’s Medicaid eligibility and enrollment process. Specifically, Harbage Consulting:


  • Provided a detailed analysis of the state’s policies and operational protocols in order to assess the current state of the program;
  • Conducted two dozen interviews with key informants and reviewed materials outlining the eligibility and enrollment process, systems, and oversight structure;
  • Developed program design recommendations for realigning the state and local staffing and organizational structure, making eligibility system improvements, enhancing the state and local training eligibility program, and broadening the state’s data sharing and oversight policies.

Medi-Cal 2020 1115 Waiver

In 2015, Harbage Consulting assisted the California Department of Health Care Services in designing and negotiating their Medicaid section 1115 waiver renewal, known as Medi-Cal 2020, and creating the program structure for the Public Hospital Re-Design and Incentives for Medi-Cal (PRIME) – formerly known as DSRIP – and the Whole Person Care pilot program.  Harbage Consulting supported the state throughout the waiver development process and during its complex negotiations with the federal Centers for Medicare & Medicaid Services.


Following approval of the waiver in January 2016, we assisted DHCS in designing and executing the application process for PRIME hospitals to qualify for the new federal Medicaid funding that is available through the waiver. We advised the state on the key application elements, evaluation criteria, and review process for PRIME and provided policy advice to the state on implementation issues writ large. Finally, as part of the program implementation process, we prepared briefing materials for use during several stakeholder webinars regarding PRIME implementation and assisted in responding to questions.

California Mental Health Services Authority

In 2015 and 2016, Harbage Consulting played a lead role in a data analysis project with the California Mental Health Services Authority (CalMHSA), which represents 56 county mental health plans across California. We worked with six CalMHSA member counties to collect and analyze county data with the goal of illustrating the risks and benefits associated with proposing changes to California’s current county mental health delivery system and financial risk structure. Harbage Consulting used this data to identify trends in access and utilization of county mental health services, county expenditures related to providing mental health services, and areas where counties were experiencing gaps between demand and access to services.

At the intersection of health care policy, politics and communications.