Experience Counts
Each state’s Medicaid program is different, so the structure of each payment enhancement is unique. While those variations are driven by the circumstances in each state, the first and most important question is always funding. Medicaid payments are a combination of state funding and federal matching funds, so any successful effort has to identify sources of state matching funds. Some of the common options include direct appropriations, provider taxes, intergovernmental transfers, and redirecting/repurposing existing funding in related programs.
The next most important issue is whether the state’s Medicaid payments are made fee-for-service or through managed care plans. The strategies for reimbursement enhancements can be dramatically different under each system. Other significant factors include whether the state has opted to expand Medicaid under the Affordable Care Act, whether classes of providers (e.g., governmentals) are included or not, how volunteer providers are addressed, and many others.
Important Distinctions
Finally, it’s important to note that these programs are not an expansion of Medicaid under the Affordable Care Act. They do not always include an assessment, and certainly not a hidden one. Finally, no fees are passed on to patients.
Medicaid Enhancement Services
Bridge Partners works with local providers and their associations to design and implement the most viable and effective Medicaid Payment Enhancement Program. The Bridge Partners process begins with understanding the provider community and their needs and goals, exploring existing Medicaid and non-Medicaid funding, preliminary analysis of voluntary survey data, meetings with state Medicaid officials, gathering the necessary political background and identifying potential allies, requesting current Medicaid payment data, and modeling options and recommendations. Once the client choses the model that best meets its goals, Bridge Partners works with the client and the state to adopt, have approved by CMS, and implement the plan.