Medicaid Financing
and Reporting
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With states facing mounting budgetary pressures and changing regulatory environments, it is important to have a trusted partner to help navigate Medicaid financing options, opportunities for federal financial participation (FFP), and compliance requirements. Myers and Stauffer works diligently with our clients to ensure they have a broad understanding of the options available and the impact of those options from both a budgetary and regulatory perspective. By delivering tailored state-specific solutions, backed by our nationwide experience and exceptional customer service, our clients can make informed and sustainable policy decisions while ensuring regulatory compliance.

Our Medicaid financing and reporting services include:

Tim Guerrant, CPA
Member
tguerrant@mslc.com

317.846.9521

Medicaid Financing Options

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Myers and Stauffer supports clients in strategically designing and implementing Medicaid financing strategies that achieve state goals, while maintaining compliance with federal Medicaid statutes and regulations. We focus on developing comprehensive strategies that leverage opportunities for federal financial participation, while maintaining state Medicaid financing options that are flexible, sound, and sustainable. Our professionals have an in-depth knowledge of the following funding systems:

  • Certified public expenditures (CPE) allow states to draw federal matching funds by certifying that public funds have been expended to support the full cost of providing a particular Medicaid-covered service or the Medicaid program administrative activity.” States may also utilize CPEs in conjunction with a supplemental payment program.
  • Intergovernmental transfers (IGT) are transfers of public funds between different governmental entities. States may use these to fill budget gaps, maintain services, and facilitate supplemental payment programs.
  • Provider tax programs are an integral source of financing for state Medicaid programs, involving the specific taxation of health care services. We assist states in program design, fiscal impact modeling, state plan amendment and administrative code changes, and performing P1/P2 and B1/B2 required reporting for the Centers for Medicare & Medicaid Services (CMS) provider tax waiver requests.
  • Supplemental payment programs are used, often in conjunction with CPE and IGT funding mechanisms, to allocate available funds for reimbursement to providers for a variety of state goals and incentives. We assist states in designing these programs, fiscal impact modeling, state plan amendment and administrative code changes, and ensuring their compliance with upper payment and other federal and state Medicaid requirements.
  • Graduate medical education (GME) payments are made to providers to help share the cost of educating residents and physicians. Myers and Stauffer assists states in determining GME payments (both direct and indirect). We have explored the use of GME payment pools to limit the states’ exposure to program growth, as well.
  • Managed care organization (MCO) utilization amongst states has become increasingly popular in recent years, and can promote innovative and cost-effective methods of delivering care to Medicaid and CHIP beneficiaries. We can assist your state with designing, implementing, and transitioning to a managed care solution. For more information on our work in managed care, please view our Managed Care page.
  • Waivers offer flexibility for states by allowing them to waive certain Medicaid program requirements in order to design and implement innovative reforms to their Medicaid programs and/or target specific beneficiary populations to receive new or additional services. We work with states to design waiver programs that meet the practical expectations of the state and appropriately securing federal matching funds to support these reforms. For more information, please view our Waivers page.

Compliance

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Myers and Stauffer has extensive experience in assisting our clients with meeting federal compliance requirements including upper payment limit (UPL) demonstrations, disproportionate share hospital (DSH) calculations, MCO, and form CMS-64 reporting. We have the necessary knowledge and technical skills to provide these analyses as required within the federal regulations, and will work to ensure that our reporting provides you with all the appropriate information needed to fulfill any requirements with CMS.

  • UPL demonstrations are an annual compliance requirement, and may also be required for submission with state plan amendment filings. Our goal is to partner with our state clients to develop a defendable UPL calculation that maximizes the Medicare and Medicaid rate differential for each provider type to both ensure federal UPL compliance and to leverage supplemental payment program opportunities.
  • DSH payments for uninsured and underinsured individuals are required to be reviewed on an annual basis to ensure that the costs of these services do not exceed the payments received for those services. Myers and Stauffer is the foremost leader in the country in providing DSH payment methodology support and DSH audit services, and we bring this nationwide experience, expertise, and knowledge to each of our client engagements. Please see our Audit page for more detailed information on our DSH services.
  • Managed care programs are required to meet certain federal requirements, while also maintaining compliance with state contract requirements. We assist Medicaid agencies with MCO program reviews, audits, and monitoring activities. These efforts are designed to assist our Medicaid agency clients in attaining the goals, objectives, and value for their managed care programs and to ensure that MCOs are performing in accordance with their contracts. For more information on our work in managed care, please view our Managed Care page.
  • CMS-64 reporting is a quarterly compliance requirement for each state. We have worked collaboratively with states and other contractors to forecast utilization and expenditures, develop budgets, and to prepare required forms to obtain appropriate federal funding.