ARTICLE;
CAPITATION FEE;
COMPARATIVE STUDY;
ECONOMICS;
FEE;
FEMALE;
FINANCIAL MANAGEMENT;
HEALTH CARE COST;
HEALTH CARE PLANNING;
HEALTH MAINTENANCE ORGANIZATION;
HUMAN;
INFORMATION PROCESSING;
MALE;
MEDICAID;
MEDICAL EDUCATION;
MEDICAL FEE;
REIMBURSEMENT;
SOCIAL SECURITY;
STATISTICS;
UNITED STATES;
AID TO FAMILIES WITH DEPENDENT CHILDREN;
CAPITATION FEE;
CONTRACT SERVICES;
DATA COLLECTION;
EDUCATION, MEDICAL, GRADUATE;
FEE-FOR-SERVICE PLANS;
FEMALE;
HEALTH CARE COSTS;
HEALTH MAINTENANCE ORGANIZATIONS;
HUMANS;
MALE;
MEDICAID;
RATE SETTING AND REVIEW;
REIMBURSEMENT, DISPROPORTIONATE SHARE;
STATE HEALTH PLANS;
UNITED STATES;
A National Survey of Medicaid Managed Care Payment Methods and Capitation Rates
Washington: Urban Institute, forthcoming
These are reported in J. Holahan et al., "A National Survey of Medicaid Managed Care Payment Methods and Capitation Rates," Assessing the New Federalism Occasional Paper (Washington: Urban Institute, forthcoming).
Ibid. We did not make any adjustments for legislative changes to rates that occurred subsequent to the initiation of contracts, presence of or variation in stop-loss arrangements, AFDC eligibility criteria (which can affect the composition of the population), unreported differences in carve-outs across states, and selection bias under capitated programs with voluntary enrollment.
In many cases, numerous counties were grouped together by Federal Information Processing Standards (FIPS) code to calculate population distributions in the state selected regions. To the extent that the Medicaid population differs by age and region from the population below 200 percent of the federal poverty level, the aggregation could be affected. Disaggregated data at the age, sex, and regional level for the Medicaid population is not as reliable in most states as the population below 200 percent of the federal poverty level. This approach could introduce some small bias, but it is at least consistent across states.
4
6244283907
note
Medicaid claims data from California, Georgia, and Tennessee showed that including foster children would increase rates by 7.2 percent in California, 1.0 percent in Georgia, and 11.5 percent in Tennessee. Including foster children would increase the statewide average rates in Exhibit 1, which include adults, by 1.7 percent in California and 5.2 percent in Tennessee but would reduce rates by 0.2 percent in Georgia.
5
0346770499
Managed Competition and California's Health Care Economy
Spring
A.C. Enthoven and S J. Singer, "Managed Competition and California's Health Care Economy," Health Affairs (Spring 1996): 39-57, Exhibit 1. California did not provide us with separate capitation rates for adults and children. The 82.75 reported in Exhibit 2 is an average of children and presumably more expensive adults. In 1996 there were 3.3 million children and 1.9 million adults enrolled in Medicaid. If the differences in costs of adults and children was 2.5:1, roughly the average for other states, then the implicit rate for adults and children would be about $133 and $53, respectively (1997-1998). The weighted average individual monthly premiums (for adult workers) reported in Enthoven and Singer were $168.63 (CalPERS), $161.74 (FEHBP-HMO), $156.75 (Stanford University), $151.89 (University of California), and $116.89 (HIPC).
Princeton, N.J.: Center for Health Care Strategies, May
See, for example, R.E. Hurley and M.A. McCue, Medicaid and Commercial HMOs: An At-Risk Relationship (Princeton, N.J.: Center for Health Care Strategies, May 1998).
