Medicaid Rate Setting & Financing
Government health care programs rely on well-designed reimbursement and financing strategies to ensure beneficiaries have access to high-quality care while maintaining responsible stewardship of public funds.
Designing Sustainable & Compliant Medicaid Payment Systems
Government health care programs rely on well-designed reimbursement and financing strategies to ensure beneficiaries have access to high-quality care while maintaining responsible stewardship of public funds. Medicaid payment systems include complex rate-setting methodologies, regulatory requirements, and financing structures that must be carefully managed to support providers, sustain program operations, and comply with federal and state policy.
As a trusted partner to state Medicaid agencies, we help design, analyze, and implement sustainable rate-setting and financing strategies across a wide range of health care services. Our team combines decades of policy expertise, advanced financial modeling, and regulatory knowledge to support reimbursement methodology development, fiscal impact analysis, and program financing initiatives. By delivering data-driven insights and practical solutions, we help agencies establish transparent, defensible payment systems that promote provider participation, ensure compliance, and strengthen the long-term sustainability of Medicaid programs.
Explore Our Rate Setting & Financing Services
Our Medicaid rate setting and financing expertise spans provider reimbursement, pharmacy pricing, financing and reporting, and supplemental payment programs. Explore the service areas below to learn more about our capabilities.
Accurate and sustainable rate setting is essential to ensuring Medicaid providers can deliver high-quality care while maintaining responsible stewardship of public funds.
We partner with state Medicaid agencies to design data-driven reimbursement methodologies that reflect the cost of care, support provider participation, and meet federal and state requirements.
Pharmacy reimbursement presents specific and dynamic challenges due to rapidly changing drug pricing dynamics, federal rebate requirements, and complex utilization patterns.
For nearly 50 years, our team has provided specialized data analysis, fiscal modeling, and rate setting services including average acquisition cost (AAC) and cost of dispensing (COD) surveys for Medicaid pharmacy programs. Our multidisciplinary team of pharmacists, accountants, and analysts brings deep expertise in navigating the evolving pharmacy landscape.
With states facing mounting budgetary pressures and evolving regulatory requirements, understanding Medicaid financing options and federal financial participation (FFP) opportunities is critical.
We help states evaluate financing strategies, assess fiscal impact, and ensure compliance with federal requirements. Our work supports informed decision-making and strengthens financial oversight across Medicaid programs.
Supplemental and directed payment programs are a critical component of Medicaid financing, enabling states to strengthen provider reimbursement, support safety-net providers, and improve access to care.
Programs such as disproportionate share hospital (DSH) payments, upper payment limit (UPL) demonstrations, Medicaid directed payments, and ground emergency medical transportation (GEMT) programs require sophisticated financial modeling, detailed provider data, and strict compliance with federal requirements.
Recent regulatory changes, including CMS-2439-F, have increased scrutiny and introduced new requirements for the design, approval, and oversight of directed payment arrangements.
We help Medicaid agencies design, evaluate, and manage these programs to ensure they are financially sound, compliant, and aligned with program goals.
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.
Amy Perry, CPA
Member
Email: aperry@mslc.com
Phone Number: 816-945-5342
John Dresslar, CPA
Member
Email:jdresslar@mslc.com
Phone Number: 223-259-5306
Joe Gamis, CFE, MBA
Principal
Email: jgamis@mslc.com
Phone Number: 816-957-6330
Tim Guerrant, CPA
Member
Email: tguerrant@mslc.com
Phone Number: 317-815-2935
In the Words of Our Clients…
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