Mr. Waldinger, an associate manager in our Boston office, focuses on Medicaid policy, analysis and implementation. He has extensive experience in state and Medicaid budgeting and finance, having served as Chief Financial Officer (CFO) and Budget Director for the Massachusetts Medicaid program, MassHealth, and, more recently, as CFO for the Massachusetts Behavioral Health Partnership, which managed the behavioral health needs of more than 300,000 Medicaid members.

 

Since joining PCG, Mr. Waldinger has served as a project manager and subject matter expert for various rate-setting, revenue enhancement, cost containment, program design, and auditing projects. Of note, Mr. Waldinger has assisted in the redesign and re-procurement of the Massachusetts Emergency Services Program (ESP), including a redesign of the clinical cost and rate components; a re-vamping of Colorado’s Accounting and Auditing Guidelines for Community Mental Health Centers, which included on-site provider trainings; an auditing project in Virginia to review clinical case files of intensive community-based services; and an audit in Massachusetts of hospital files for compliance with the Health Safety Net program.

Expertise

  • Health care reform, state Medicaid finance, policy and implementation matters

Experience

While at MassHealth, Mr. Waldinger focused on calculating and tracking hospital payment mechanisms, including Upper Payment Limit (UPL), Disproportionate Share Hospital (DSH), and other supplemental payments. Mr. Waldinger also served as MassHealth’s lead finance analyst during the creation of Massachusetts’s landmark Health Care Reform legislation. He created the financial documents used in submission of Health Care Reform 1115 waiver to the Centers for Medicare and Medicaid Services (CMS). As CFO for the Massachusetts Behavioral Health Partnership (MBHP) – the state’s behavioral health carve-out vendor – Mr. Waldinger re-vamped the organization’s medical cost projection and methodologies and calculated and implemented aggressive inpatient pay-for-performance measures.

Education and Associations

Mr. Waldinger received his B.A. in Communications from the University of Connecticut and completed a Master’s Degree in Public Administration (MPA) at Northeastern University in Boston.

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Contact

To learn more about Jim Waldinger or other PCG Health Subject Matter Experts, contact us at info@publicconsultinggroup.com or 1-800-210-6113.