Eyman Associates has particular legal and practical expertise in helping providers support their missions through the Medicaid program. We have a sophisticated technical understanding of the web of financing streams available to Medicaid providers and the complex requirements governing their use. Such an understanding is critical to preserving these essential funding streams as state Medicaid programs evolve. Disproportionate share hospital payments, graduate medical education payments, other supplemental (“upper payment limit” or “UPL”) payments, supplemental physician payments, waiver-based payment pools, and managed care payments have all proved to be major lifelines for our clients, and will continue to be critical as coverage expands and Medicaid grows. At the same time, these programs require viable and permissible funding sources for the state’s share of these payments—including intergovernmental transfers, certified public expenditures and state and local provider taxes—especially as states’ ability to devote general revenue funds to this support dwindles. Our experience working with Medicaid programs in over 30 states, and our knowledge of evolving and often unwritten federal policies, provides our clients with key insights and strategies for using Medicaid to fund their mission.
Delivery System Reform
The Medicaid program offers a number of levers through which states can promote transformation of the health care delivery system to enhance access and quality, particularly for low income and vulnerable populations. It’s not enough just to import models developed for the commercial or Medicare markets into Medicaid—the vast differences in population present challenges requiring unique approaches. Eyman Associates has worked extensively with providers and with states to develop and implement tailored programs to promote quality, access and value in Medicaid, through state plan amendments, waivers (particularly Delivery System Reform Incentive Payments (DSRIPs) and related programs), managed care contracting and other mechanisms. Contact us to learn more about how Medicaid can support your redesign goals.
Has your state expanded Medicaid yet? If not, your challenges are likely multiplying as uncompensated care grows and federal support dwindles. Eyman Associates can help develop creative approaches to expanding Medicaid to address state concerns about resources, incentives, cost, financing, efficiency quality and promoting the private sector. And whether or not your state has expanded Medicaid, we can work with you to reduce gaps, smooth transitions and expand coverage among and between programs including Medicaid, Medicare, dual eligibility, Marketplace Exchanges, Basic Health Program, Section 1332 waiver programs and state and local initiatives.
States are increasingly operating their Medicaid programs through federal waivers. Waivers provide maximum flexibility to design unique programs, test out new approaches and implement innovations unconstrained by federal laws and policies written in a different era with a vastly different programmatic model in mind. Medicaid waivers are subject to federal approval through a process that, despite efforts to the contrary, lacks basic transparency. Understanding the process, the often unwritten approval criteria, the necessary design elements, and key concepts such as budget neutrality and expenditure authority is difficult if not impossible without the assistance of an experienced guide. Eyman Associates has been deeply involved in the development and implementation of Medicaid waivers since the early 1990s. We have witnessed their evolution from early state based coverage expansions such as TennCare through the more recent innovations in transforming delivery systems through Delivery System Reform Incentive Payment (DSRIP) programs, regional care organizations and related system redesign initiatives. See our related Resource Page on DSRIP programs. We can help guide you through the waiver amendment or renewal process, help you understand the contours of existing waiver programs and help design and implement new programs.
Over two-thirds of Medicaid beneficiaries are now enrolled in managed care systems, which present a new set of opportunities and challenges for states, providers and beneficiaries alike. In April 2016, CMS finalized an overhaul of federal regulations governing Medicaid managed care, which will have an enormous impact on the way states run their programs. Eyman Associates attorneys have been deeply involved in federal policymaking in the Medicaid managed care arena since before the first set of comprehensive managed care laws were adopted in the Balanced Budget Act of 1997. We can bring that depth of experience to bear in helping you develop and flourish in a Medicaid managed care environment.