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Lillian S. Spuria

Lillian Spuria is the Director of Government Policy & Reimbursement with Gjerset and Lorenz, LPP, where she focuses on assisting hospital providers with their participation in Medicaid supplemental payment programs under both state plan and waiver activity, including provider tax-funded payment programs and delivery system reform incentive payment programs. Ms. Spuria also assesses national trends in federal Medicaid waiver policy and impacts on the Texas 1115 waiver.

Ms. Spuria has significant experience in the fields of Medicaid policy and financing, including Section 1115 Medicaid Waivers, health care reform, and hospital incentive payment programs.

Ms. Spuria has experience working with hospital systems and State agencies to develop Medicaid revenue streams necessary to ensure access to care for Medicaid beneficiaries and other low-income individuals. Her experience includes:

  • Designing targeted Medicaid expansion programs under Section 1115 Medicaid Waiver authority on behalf of hospital provider systems seeking to provide health coverage to uninsured populations.
  • Assisting hospitals to gain State approval, operate, and earn incentive payments for Medicaid delivery system reform programs.
  • Establishing delivery system reform incentive program pools under Section 1115 waivers.
  • Negotiating Section 1115 Medicaid Waiver program terms with the Centers for Medicare and Medicaid Services.
  • Assessing the impact of health care reform changes regarding State Medicaid programs and hospital providers.

Prior to joining Gjerset and Lorenz, LLP, Ms. Spuria worked for the White House Office of Management and Budget (OMB) for thirteen years and for a national private healthcare consulting firm for three years.

At OMB, Ms. Spuria was Chief of the Medicaid Branch within the Health Division. In that position, she led a professional staff in helping formulate legislative and regulatory agenda for Medicaid and State Children Health Insurance Program.   During her tenure at OMB, she developed budget and policy recommendations for senior White House and OMB officials on issues related to Medicaid reform, federal reimbursement policy, disability and long term care, and managed care.