Medicaid Financing 2018-11-19T19:34:36+00:00

Medicaid Financing

With a highly experienced practice in Medicaid financing, Sellers Dorsey has been assisting clients in identifying, developing and implementing innovative strategies to fund and strengthen their Medicaid programs since our inception in 2000. Our work has yielded more than $14 billion in new federal Medicaid funding that has been used to expand healthcare services, provide additional access to specialists and other medical professionals, and otherwise transform healthcare systems for people across the country. This record of success is greater than that of any other firm in the United States to our knowledge.

CLIENTS AND SERVICES
Medicaid Financing Expertise Tailored for Clients

Our Medicaid financing initiatives are highly tailored for each client. Our projects are designed to meet our clients’ goals, as well as the policy objectives of state Medicaid programs and their federal partners at CMS. Working at the intersection of industry and government, our services include developing programs that improve the access and quality of healthcare and increase reimbursement for Medicaid services in both fee for service and managed care environments.

Take a look at our capabilities with the various (kinds of) clients we serve:

  • Medicaid revenue opportunity assessment
  • Upper payment limit (UPL) programs
  • Medicaid supplemental payment programs in fee for service and managed care
  • Disproportionate Share Hospital (DSH) payment programs
  • Value-based payment (VBP) and alternative payment model programs
  • Medicaid Graduate Medical Expense (GME) reimbursement programs
  • Delivery system reform incentive payment (DSRIP) programs
  • Provider assessment initiatives
  • Medicaid revenue opportunity assessment
  • Upper payment limit (UPL) programs in Medicaid fee-for-service
  • Medicaid supplemental or enhanced payment programs in managed care
  • Value-based payment (VBP) and alternative payment programs
  • Medicaid Graduate Medical Expense (GME) reimbursement programs
  • Identification, design, Federal approval and implementation of statewide Medicaid financing initiatives
  • Policy analysis, including compliance with federal rules and guidance
  • Development and negotiation of Medicaid Waivers, including 1115 State Demonstration Waivers
  • Medicaid State plan amendments (SPAs)
  • Upper payment limit (UPL) programs in Medicaid in fee-for-service
  • Supplemental or enhanced payments in Medicaid managed care
  • Provider assessments (hospital, nursing facility, ICFMR, managed care, and other)
  • Legislative analysis
  • Certified public expenditure (CPE) initiatives
  • Intergovernmental transfers (IGT) initiatives
  • Managed care contract drafting and amendments that drive quality through value based purchasing or alternative payment models
  • Development of Medicaid GME Programs
  • Reform and maximization of DSH programs
  • Medicaid revenue opportunity assessment
  • Value-based payment (VBP) and alternative payment model programs
  • Medicaid supplemental payment programs in fee for service and managed care
  • Upper payment limit (UPL) programs in Medicaid fee-for-service
  • Provider assessment initiatives
  • Assessment of opportunities in Medicaid for various state provider associations, advocacy organizations, trade associations, and other consumer and employee organizations
  • Provider assessment programs including modeling and payment mechanisms
  • Assessment initiatives and other supplemental payment programs in Medicaid managed care
  • Upper payment limit (UPL) programs in Medicaid fee-for-service
  • Delivery system reform and payment mechanism including value based purchasing or alternative payment models

OUR TEAM
Medicaid Financing Experts Who Get Things Done

Get to know our experts and how you can benefit from their experience. Sellers Dorsey includes former state Medicaid officials and Medicaid Directors, hospital and health plan executives, clinicians, and provider organization leaders responsible for the development, financing, administration and operation of Medicaid programs and healthcare delivery in various settings and through both fee-for-service and Medicaid managed-care delivery systems. These are just some of the seasoned Medicaid financing experts at Sellers Dorsey:

Martin D. Sellers
Co-Founder and CEO
Nancy Enright, PMP
Director of Client Servicing
Scott Reasonover, CPA
Senior Consultant
Jeff Harris
Senior Consultant
Matthew Bucknell
Senior Consultant
Tom Traylor
Senior Strategic Advisor
Bob Lux
Senior Strategic Adivsor
John Seaver
Senior Strategic Advisor
Nancy Kohler
Senior Consultant
Brody McClellan
Senior Consultant

Marty is the co-founder and CEO of Sellers Dorsey. With 30+ years’ experience in the public and private sectors, his novel healthcare approaches have impacted nationwide reforms at both state and federal levels, including the development of the groundbreaking universal healthcare program in Massachusetts. Before founding Sellers Dorsey, Marty also helped forge one of the largest state-based government relations firms in the country.

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Nancy ensures the delivery of contracts spanning fifteen states. Her Medicaid reimbursement experience has yielded clients at least $210 million in new federal Medicaid reimbursement in the last three years, and her expertise includes Medicaid financing, quantitative research, statistical analysis and UPL programs in managed care and fee-for-service.

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With 30+ years of Medicaid rate-setting and reimbursement, Scott has designed DSH and UPL programs, given guidance on CMS reimbursement, led database management, and advised on Medicaid administrative operations. Prior to Sellers Dorsey, he served as both Director of Hospital Rate Analysis and Reimbursement Analyst with Texas Health and Human Services Commission (HHSC).

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Jeff’s 25 years in navigating health policies with Medicaid and the uninsured have made him a policy expert for clients. He assists state and local governments and providers with innovating Medicaid financing programs, and he connects private hospitals or nursing homes with their public counterparts in mutually, financially beneficial partnerships. Jeff also offers guidance on CMS reimbursement policy.

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Matt Bucknell offers 10+ years’ experience in federal and state health policy matters. Not only does he provide policy analysis and technical support for Medicaid financing engagements, he also specializes in evaluating/modeling provider assessments, performing budget neutrality calculations, and designing certified public expenditures and upper payment limit programs

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Tom Traylor serves as Senior Strategic Advisor for Sellers Dorsey, having recently concluded his 20-year tenure as Vice President for Federal, State and Local Programs at Boston Medical Center (BMC). As Senior Strategic Advisor, Tom works with the firm to help hospitals and health plans across the country to further their missions to deliver quality care to vulnerable populations by leveraging the firm’s Medicaid financing and policy expertise.

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Bob Lux helps hospitals and health plans across the country ensure and enhance their ability to deliver quality, affordable care. Before joining the firm, he served for more than 20 years as CFO of Temple University Health System in Philadelphia. During that time Bob became familiar with the work of Sellers Dorsey, which collaborated with Bob on initiatives to increase critical federal Medicaid revenues for Temple Health.

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John’s expertise is rooted in years of providing independent health policy and finance consulting services, including reimbursement and financing for hospitals and hospital associations. He is highly skilled in uninsured and safety-net policy and financial analysis/modeling, Medicaid reform strategies, certified public expenditure solutions, provider rate development, and supplemental payment programs within fee-for-services and Medicaid managed care.

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A resident Value-Based Purchasing (VBP) expert, Nancy works with clients on VBP in Medicaid managed care and Medicaid financing. Prior to Sellers Dorsey, she was integral to PA’s Statewide Quality Care Assessment, and her comprehensive experience includes public health program operations, policy development, implementation, fiscal analysis, and strategic positioning.

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While employed with the actuarial division of the State of Michigan Medicaid Office, Brody helped design one of the largest fee-for-service UPLs in the country and later expanded the program to include the Michigan Medicaid managed care environment. Following these achievements, Brody worked for Michigan State University as lead project manager for the college’s Medicaid Access to Care Program.

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CLIENT STORIES
Medicaid Financing Project Experience

Sellers Dorsey’s work with clients on Medicaid financing initiatives from design to implementation has resulted in more than $14 billion in new federal Medicaid funding which is, to our knowledge, more than any other revenue enhancement firm in the United States. Our special area of expertise is in designing new approaches to revenue enhancement that are tailored to a specific client’s situation and goals.Our reputation in this field is one of innovation and accomplishment. We developed the conceptual frameworks for and worked with clients to design and implement:

  • The first ever physician UPL program, for the Commonwealth of Kentucky
  • The first ever local hospital assessment, for the Commonwealth of Pennsylvania
  • One of the first non-healthcare related provider assessments for Medicaid Managed care plans, for the Commonwealth of Pennsylvania

Most recently, Sellers Dorsey has achieved success on behalf of clients in obtaining CMS approval on 14 new Medicaid financing initiatives in 10 different states since the beginning of the current administration!

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EVENTS AND CONFERENCES
Opportunities to Grow Knowledge and Relationships

Through our ongoing work and our relationships with key decision makers and thought leaders in the private sector and in state and federal governments, Sellers Dorsey remains well informed of the latest rules and guidance from CMS and trends and innovations emerging from the private sector. Our staff regularly communicates with leaders and staff of organizations and affiliations in the industry, and they attend events with these influencers and decision makers year-round.

Please let us know if you would like to meet a member of our team at an upcoming event. If you are an event organizer and are interested in hearing one of our thought leaders speak to your audience, please contact us at [email protected]

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Contact Sellers Dorsey

If you would like additional information or wish to speak to any of our experts about issues facing your managed care organization, please get in touch and we will have a conversation at a time that's best for you.