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Explanatory analysis, timely perspectives, and the complete publication archive.

Insights — explanatory analysis

Perspectives — timely commentary

Reference Library

Shadow PERM Implementation Guide

Tools

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Aug 27, 2026

Shadow PERM Implementation Guide

An operational framework for state Medicaid leaders using internal eligibility sampling to identify accuracy, audit-defensibility, and control failures before federal selection.

Ralph Choate
Ralph Choate
PERM Pre-Cycle Readiness Matrix

Tools

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Aug 26, 2026

PERM Pre-Cycle Readiness Matrix

An operational assessment for state Medicaid leaders testing policy, system, operational, and stakeholder readiness before the next PERM cycle.

Ralph Choate
Ralph Choate
Source Presentation: Wyoming’s PERM Transformation Through System Modernization

References

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Aug 26, 2026

Source Presentation: Wyoming’s PERM Transformation Through System Modernization

Presented by the Wyoming Department of Health and Acentra Health at MESC 2026, August 19, 2026.

Self-Attestation: Executive Control Checklist

Tools

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Aug 26, 2026

Self-Attestation: Executive Control Checklist

A readiness guide for Medicaid leaders balancing administrative simplicity, eligibility accuracy, audit defensibility, and fiscal exposure.

Ralph Choate
Ralph Choate
Self-Attestation Is Not the Risk. Uncontrolled Self-Attestation Is.

Insights

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Aug 26, 2026

Self-Attestation Is Not the Risk. Uncontrolled Self-Attestation Is.

Why Medicaid leaders should distinguish access-friendly policy from weak evidence, inconsistent controls, and downstream fiscal exposure.

Ralph Choate
Ralph Choate
PERM Eligibility Risk: Executive Readiness Snapshot

Tools

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Aug 26, 2026

PERM Eligibility Risk: Executive Readiness Snapshot

A concise framework for Medicaid leaders assessing eligibility accuracy, audit defensibility, and fiscal exposure.

Ralph Choate
Ralph Choate
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PERM Insights & Perspectives

Independent research and practical analysis of Medicaid eligibility accuracy, operational accountability, and fiscal exposure.

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