What we do

Provider Reimbursement & Financing 

Medicaid provider reimbursement and financing are essential to ensuring sustainable, equitable access to healthcare services. We partner with state Medicaid agencies to design and implement effective, compliant payment systems that promote transparency, financial stability, and alignment with program goals.

Two female doctors smile while looking at a tablet.

Supporting Medicaid Payment Systems, Rate Setting, & Program Financing 

Provider reimbursement and financing are central to the design and sustainability of Medicaid programs. States must develop and manage payment methodologies that are compliant with federal requirements, financially sound, and aligned with program goals, while ensuring access to care and appropriate provider participation. 

Medicaid financing structures are complex, involving a combination of base payment methodologies, supplemental payments, cost reporting, and federal funding considerations. These components must work together to support accurate reimbursement, transparency, and long-term program stability. 

We support state Medicaid agencies in designing, evaluating, and managing provider reimbursement and financing strategies. Our work provides independent, objective analysis to support payment accuracy, regulatory compliance, and effective program administration. 

Our Approach to Medicaid Reimbursement & Financing 

Effective reimbursement systems require coordination across policy, financial modeling, and program operations. Our approach focuses on: 

  • Aligning payment methodologies with program design and policy objectives. 
  • Supporting transparency and defensibility in reimbursement decisions. 
  • Ensuring compliance with federal Medicaid requirements. 
  • Integrating financial modeling with real-world program operations. 
  • Providing data-driven insights to inform policy and planning. 

Comprehensive Medicaid Reimbursement Solutions

Navigating the complexities of Medicaid reimbursement requires a careful balance between regulatory compliance, cost efficiency, and program goals. Our expertise supports agencies in designing, analyzing, and implementing payment systems that align with federal standards while meeting the unique needs of providers and beneficiaries.

Medicaid rate setting must balance regulatory requirements, provider costs, and program goals. States must develop methodologies that are transparent, supportable, and aligned with federal expectations.

We support agencies in:

  • Designing and refining reimbursement methodologies across provider types.
  • Developing fee schedules and cost-based payment approaches.
  • Conducting financial and rate impact analysis.
  • Evaluating alignment with Medicare and other benchmarks.
  • Supporting documentation and approval processes.
Explore Rate Setting & Financing

Cost reporting is a foundational component of many Medicaid reimbursement systems, particularly for institutional providers and supplemental payment programs.

We assist agencies in overseeing cost reporting and ensuring accurate, supportable reimbursement.

Our services include:

  • Cost report collection, review, and audit support.
  • Evaluation of cost-based reimbursement methodologies.
  • Analysis of provider cost structures and trends.
  • Integration of cost reporting with rate setting and supplemental payments.
  • Support for audit, appeals, and regulatory reviews.
Explore Cost Report Audit & Attest

Supplemental and directed payments are key tools for strengthening provider reimbursement and advancing Medicaid program goals. These programs require sophisticated financial modeling, detailed data analysis, and strict compliance with federal requirements.

We support agencies in:

  • Designing supplemental payment methodologies, such as disproportionate share hospitals (DSH, upper payment limit (UPL), and others.
  • Developing and evaluating directed payment programs.
  • Conducting financial modeling and fiscal impact analysis.
  • Supporting documentation, Centers for Medicare & Medicaid Services (CMS) approval, and compliance.
  • Monitoring program performance and sustainability.
Explore Supplemental & Directed Payments

Sound reimbursement decisions depend on accurate financial modeling and a clear understanding of program impacts.

We develop models and analyses that allow agencies to:

  • Evaluate the financial impact of policy and rate changes.
  • Assess provider-level and system-wide reimbursement effects.
  • Analyze utilization and cost trends.
  • Support budgeting, forecasting, and long-term planning.
  • Inform strategic decision-making.

Accurate data is essential to supporting reimbursement methodologies and ensuring payment integrity. Agencies must validate the data used in rate setting, cost reporting, and supplemental payment programs.

We support agencies in:

  • Validating financial, cost, and utilization data.
  • Identifying discrepancies and data quality issues.
  • Evaluating data collection and reporting processes.
  • Supporting defensible reimbursement calculations.
  • Strengthening controls over payment-related data.
Explore Financial Data Validation
Explore Payment Integrity

Medicaid reimbursement systems are often influenced by Medicare payment methodologies and broader health care financing considerations.

We help agencies:

  • Benchmark Medicaid reimbursement against Medicare payment systems.
  • Align reimbursement approaches across programs and provider types.
  • Evaluate UPL requirements.
  • Integrate reimbursement strategies with broader financing initiatives.
Explore Medicare Services

Provider reimbursement and financing are closely connected to Medicaid delivery models and program integrity efforts. Effective oversight requires coordination across these areas.

We support agencies in:

  • Aligning reimbursement strategies with fee-for-service and managed care delivery models.
  • Supporting audit and compliance activities related to payment systems.
  • Identifying risks related to reimbursement, billing, and data reporting.
  • Providing insights that inform broader program oversight.
Explore Delivery & Payment Models
Explore Program Integrity Oversight & Compliance
proven reimbursement strategies

Supporting Sustainable Medicaid Financing 

We work with agencies to strengthen Medicaid reimbursement systems through thoughtful policy design, rigorous financial analysis, and effective program oversight. Our focus is on supporting sustainable financing strategies that ensure access to care while maintaining accountability for the use of public funds. 

Experience & Approach 

Our reimbursement and financing work is grounded in decades of experience supporting state Medicaid agencies. We bring: 

  • Deep knowledge of Medicaid payment systems and financing structures. 
  • Experience across diverse provider types and program designs. 
  • Advanced financial modeling and analytical capabilities. 
  • An independent and objective perspective. 

We tailor our approach to each state’s program structure, regulatory environment, and policy priorities — delivering solutions that are both practical and sustainable. 

Results & Outcomes 

Our provider reimbursement and financing services support: 

  • Accurate and defensible reimbursement methodologies. 
  • Improved transparency in payment systems. 
  • Compliance with federal and state requirements. 
  • Enhanced financial planning and program sustainability. 
  • Better alignment across Medicaid and related programs. 
The Transformative Power of Partnership

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.

Tara Clark, CPA
Member

Email: tclark@mslc.com
Phone Number: 888-749-5799

Tim Guerrant, CPA
Member

Email: tguerrant@mslc.com
Phone Number: 317-815-2935

Joe Gamis, CFE, MBA
Principal

Email: jgamis@mslc.com
Phone Number: 816-957-6330

Ryan Farrell, CFE
Principal

Email: rfarrell@mslc.com
Phone Number: 512-342-0800

In the Words of our Clients…

Myers & Stauffer is a highly knowledgeable and accessible contractor that knows our programs and system as well or better than our own staff. They are always willing to provide as much assistance/support as needed, and deliverables are received timely and at a reasonable cost.” 

Sharing Knowledge & strengthening programs

Recent Insights

We’re committed to advancing government health care through thought leadership, collaboration, and the open exchange of ideas that drive better outcomes. Explore our latest blogs, client alerts, case studies, and thought leadership to see how our expertise can support your goals.

Explore Insights