Medicaid managed care payment methods and capitation rates in 2001

Health Affairs

Volumn 22, Issue 1, 2003, Pages 204-218

  Holahan, John ^a   Suzuki, Shinobu ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAPITATION FEE; COMPARATIVE STUDY; DIAGNOSIS RELATED GROUP; ECONOMICS; FEE; FINANCIAL MANAGEMENT; HEALTH CARE PLANNING; HEALTH MAINTENANCE ORGANIZATION; HUMAN; INFORMATION PROCESSING; INTERPERSONAL COMMUNICATION; MEDICAID; MEDICARE; METHODOLOGY; RISK ASSESSMENT; SOCIAL SECURITY; STATISTICAL ANALYSIS; STATISTICS; UNITED STATES;

ACTUARIAL ANALYSIS; AID TO FAMILIES WITH DEPENDENT CHILDREN; CAPITATION FEE; COMPETITIVE BIDDING; DATA COLLECTION; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; MEDICAID; MEDICARE; NEGOTIATING; OUTLIERS, DRG; RATE SETTING AND REVIEW; RISK ADJUSTMENT; STATE HEALTH PLANS; UNITED STATES;

EID: 0037271248     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.1.204     Document Type: Review

References (18)

1. Centers for Medicare and Medicaid Services, "Medicaid Managed Care Enrollment Report, Summary Statistics as of June 30, 1997," and "Medicaid Managed Care Enrollment Report, Summary Statistics as of June 30, 2001," www.cms.gov/medicaid/mcaidsad.asp (15 October 2002).
2. J. Holahan, J.M. Wiener, and A.W. Lutzky, "Health Policy for Low-Income People: States' Responses to New Challenges," 22 May 2002, www.healthaffairs.org/WebExclusives/Holahan_Web_Exd_052202.htm (15 October 2002);
3. and S. Felt-Lisk, R. Dodge, and M. McHugh, "Trends in Health Plans Serving Medicaid - 2000 Data Update" (Washington: Kaiser Commission on Medicaid and the Uninsured, November 2001).
4. T.A. Coughlin, S.K. Long, and J. Holahan, "Commercial Health Plan Participation in Medicaid Managed Care: An Examination of Six Markets," Inquiry (Spring 2001): 22-34.
5. J. Holahan, S. Rangarajan, and M. Schirmer, "Medicaid Managed Care Payment Rates in 1998," Health Affairs (May/June 1999): 217-227.
6. Space precludes us from presenting data on Medicaid managed care penetration in the states. These data are available on request from John Holahan, jholahan@ui.urban.org.
7. J. Holahan and S. Suzuki, "Medicaid Managed Care Payment Methods and Capitation Rates in 2001: Results of a New National Survey" (Working Paper, Urban Institute, 2002).
8. R. Kronick et al., "Diagnostic Risk adjustment For Medicaid: The Disability Payment System," Health Care Financing Review (Spring 1996): 7-33.
9. Johns Hopkins Bloomberg School of Public Health, Health Services Research and Development Center, "The Johns Hopkins University ACG Case Mix Adjustment System - Documentation for PC-DOS and UNIX Version 4.1," 1998, www.acg.jhsph.edu (15 October 2002).
10. Holahan and Suzuki, "Medicaid Managed Care Payment Methods."
11. Holahan Suzuki, Medicaid Managed Care Payment Methods Ibid.
12. We used a three-year average of Current Population Survey (1997-1999) data for all adjustments that were made prior to aggregating across age, sex, and region - for example, to calculate separate weights for AFDC/TANF and poverty-related women. Since aggregation required county-level data, we used 1990 U.S. census data to create age/sex-specific population weights by county. The Actuarial Research Corporation (ARC) provided estimates of carve-out dollar amounts by the six age/sex categories and calculated population weights for these groups using 1999 and 2000 (March 2000 and 2001) CPS data. These weights take into account the delinking of Medicaid and AFDC/TANF. We used the population weights calculated by the ARC to aggregate across the six age/sex categories to obtain statewide capitation rates.
13. A more complete description of these adjustments is available in Holahan and Suzuki, "Medicaid Managed Care Payment Methods."
14. Urban Institute estimates from HCFA-2082 data for 1998.
15. Rates for 1998 and 2001 are calculated using the same weights: We used 1990 U.S. census data to aggregate across counties and then used 1999 and 2000 (March 2000 and 2001) CPS data to aggregate across the six age/sex categories.
16. J.M. Grossman, B.C. Strunk, and R.E. Hurley, Reversal of Fortune: Medicare+Choice Colides with Market Forces, Issue Brief no. 52 (Washington: Center for Studying Health System Change, May 2002).
17. Data from "Exhibit 3.3: Increases in Employer Health Insurance Premiums Compared to Increases in Overall Inflation and Workers' Earnings, 1989-2001," in C. Williams et al., Trends, and Indicators in the Changing Health Care Marketplace, 2002, Chartbook (Washington: Henry J. Kaiser Family Foundation, May 2002).
18. Data from "Figure 1: Trends in M+C Spending, Commercial Premiums and Commercial Health Care Costs, 1994-2001," in Grossman et al., Reversal of Fortune.