A state government wished to create a universal healthcare program by expanding Medicaid and using subsidized insurance products through the private sector. When the project began, Sellers Dorsey was assisting two healthcare providers within the state, offering technical and strategic advice; recognizing the value our firm brought to the initiative, the state requested that we work directly on the financial components of the 1115 waiver development and negotiation.

The Collaboration

Financing for the program was secured by overhauling the state’s existing 1115 waiver that was set to expire. By collaborating with CMS, state officials, and the state’s safety-net hospitals, our team helped negotiate a three-year extension along with a new payment methodology which extended federal Medicaid funding to state programs that were not previously eligible for federal Medicaid match. This new waiver authority generated significant ongoing federal funding for the new program.

The Results

Through the help of our extensive collaboration, the new methodology became the first of its kind to win CMS approval. The funding mechanism served as a pillar in the state’s plan to expand healthcare coverage to the uninsured, and as a result of its success, other states incorporated the same financing methodology in their own programs.