Delivery & Payment Models
Myers & Stauffer helps state Medicaid agencies design, implement, evaluate, and oversee Medicaid delivery systems and payment models through consulting, financial analysis, reimbursement, managed care, and program integrity services. Our expertise spans fee-for-service (FFS), Medicaid managed care, supplemental and directed payments, provider reimbursement, and Medicaid financing, helping agencies strengthen payment accuracy, ensure regulatory compliance, improve program performance, and build sustainable, high-performing Medicaid programs.
Supporting Medicaid Delivery Systems & Payment Structures
Medicaid programs are delivered through a combination of fee-for-service (FFS) and managed care models, supported by a range of supplemental and directed payment mechanisms. These delivery and payment models form the foundation of how services are financed, administered, and overseen.
Each model introduces unique considerations related to reimbursement, compliance, data reporting, and program oversight. As states continue to evolve their programs — expanding managed care, refining payment methodologies, and implementing new federal requirements — agencies must ensure these models operate effectively both independently and as part of an integrated system.
We support state Medicaid agencies in evaluating, implementing, and overseeing delivery systems and payment models across the full spectrum of Medicaid programs. Our work provides independent, objective analysis to strengthen payment accuracy, improve transparency, and support effective program administration.
Our Approach to Medicaid Delivery Systems
Medicaid delivery and payment models are highly interconnected. Decisions in one area, such as managed care rate setting or supplemental payment design, can have significant impacts across the broader program.
Our approach focuses on:
Our Delivery Model Support
Fee-for-service programs provide direct reimbursement to providers based on submitted claims. These programs require strong oversight to ensure that payments are accurate, services are appropriate, and billing requirements are met.
We support agencies in strengthening FFS program performance through:
Managed care programs shift responsibility for service delivery and administration to contracted health plans, requiring robust oversight to ensure compliance, performance, and accountability.
We assist agencies in overseeing managed care programs through:
In addition to operational oversight, effective managed care programs require focused program integrity efforts to ensure data accuracy, payment alignment, and accountability across health plans and their vendors.
Supplemental and directed payment programs play a critical role in strengthening provider reimbursement and aligning payment approaches across delivery systems. These programs support safety-net providers, advance policy goals, and help ensure access to care.
We support agencies in designing and managing these programs through:
How Delivery & Payment Models Work Together
Medicaid delivery systems are not siloed. Fee-for-service, managed care, and supplemental payment programs are interconnected and must be managed in a coordinated manner.
Our integrated approach allows agencies to:
Integration with Program Integrity & Reimbursement
Delivery and payment models are closely tied to broader program integrity and reimbursement activities. Effective oversight requires coordination across these areas.
We support agencies in:
Why Agencies Hire Myers & Stauffer
Our work is underpinned by five decades of experience supporting Medicaid programs across diverse delivery systems and payment structures. We bring:
We tailor our approach to each state’s program structure, regulatory environment, and policy priorities, delivering solutions that are both practical and sustainable.
Our delivery and payment model support helps agencies achieve:
We work with agencies to strengthen Medicaid delivery and payment models through integrated analysis, independent oversight, and data-driven insights. Our focus is on helping states build coordinated, sustainable programs that ensure access to care while maintaining accountability for the use of public funds.
Connect With Our Team
Partner with experts who understand the complexities of health and human services programs. Let us guide your organization through the industry’s unique challenges and opportunities.
Bob Hicks, CPA
Member
Email: bhicks@mslc.com
Phone Number: 816-957-6220
Email: ksorensen@mslc.com
Phone Number: 919-829-7429
In the Words of our Clients…
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