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 $19 billion in new federal Medicaid funding that has been used to expand health care services, provide additional access to specialists and other medical professionals, and otherwise transform health care 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 health care 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:
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 $19 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 39 new Medicaid financing initiatives in 18 different states since 2017!
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 info@sellersdorsey.com.
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.