Managed Care Enrollment & Capitation Rates

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State Arizona California Florida Illinois Indiana Kentucky Massachusetts Michigan New York Ohio Pennsylvania Texas West Virginia Wisconsin

Statewide Adjusted Medicaid Managed Care Capitation Rates, 2001 2 3 State CPS National CPS $131.54 $141.42 $137.79 $134.46 $135.82 $126.45 $146.36 $148.32 $164.84 $174.14 $191.95 $192.74 $170.96 $170.96 $105.35 $105.01 $149.41 $143.79 $162.30 $168.07 $132.52 $132.50 $127.63 $129.36 $143.81 $135.49 $132.44 $133.20

State Arizona California Florida Illinois Indiana Kentucky Massachusetts Michigan New York Ohio Pennsylvania Texas West Virginia Wisconsin

Medicaid Managed Care Enrollment as of June 30, 2001 4 5 Medicaid Enrollment Managed Care Enrollment % in Managed Care 549,318 527,674 96.06% 5,487,094 2,870,514 52.31% 1,923,121 1,184,506 61.59% 1,455,621 136,497 9.38% 616,752 433,014 70.21% 607,702 489,711 80.58% 954,841 616,241 64.54% 1,137,599 1,023,264 89.95% 2,803,470 728,709 25.99% 1,293,390 277,617 21.46% 1,369,181 1,037,374 75.77% 1,821,570 753,613 41.37% 264,087 122,230 46.28% 514,658 266,577 51.80%

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572 89.31% 1.27% 1. 2003.284 47. Health Affairs. (6) disproportionate-share hospital (DSH) payments.386.318 3.900 69. and the medically needy.03% 672. (4) maternity care.218. and (8) reinsurance. and selection bias under voluntary capitation rates.366 149.628 1. reinsurance arrangements.pdf 8 Centers for Medicare & Medicaid Services.49% 3. 22: 204-218.791.866 92.282 363.605 1.State Arizona California Florida Illinois Indiana Kentucky Massachusetts Michigan New York Ohio Pennsylvania Texas West Virginia Wisconsin Medicaid Managed Care Enrollment as of December 31.889 525.395 8. Available at http://www. 5 The unduplicated managed care enrollment statistics include members receiving comprehensive and limited benefits.186 577. the research does not include State Children’s Health Insurance Program (SCHIP) members.477 50. .34% 1. Capitation rate adjustments include modifications for (1) age. 4 The unduplicated Medicaid enrollment statistics consist of members in State health care reform programs that expand eligibility beyond conventional Medicaid eligibility standards.743.101.209 808. The adjustments do not account for a change in rates due to an introduction of new contracts.523. "Medicaid Managed Care Payment Methods and Capitation Rates in 2001”.290.598 486. 3 The population weights are based on the national Medicaid population according to 2000-2001 CPS.119 2.653.261 1. (3) HIV/AIDS.155.34% 761.322.00% 2.128 49.cms.315.745 29. unreported variations in carved-out services.887 80.190 57.51% 1. 2003”.hhs.gov/medicaid/managedcare/mcsten01.42% 6. 2 1 The population weights are based on each state’s Medicaid population according to 2000-2001 Current Population Survey (CPS).96% 772.12% 928.465. (7) graduate medical education (GME) payments. adjustments are configured to account for variations in certain areas.923 619.363 64. (5) carve-outs . the elderly and disabled. (2) health status.870 41.511 148. sex & region. “Medicaid Managed Care penetration rates by state June 30. however.89% 2.53% 296.146. John and Shinobu Suzuki.947 62.04% 8 Notes: To compare capitation rates. The study includes information for capitated HMO programs for Aid to Families with Dependent Children/Temporary Assistance for Needy Families (AFDC/TANF) and poverty-related eligibility groups.195 1. 2003 4 5 Medicaid Enrollment Managed Care Enrollment % in Managed Care 904.571 99. Sources: 6 Holahan. 7 Centers for Medicare & Medicaid Services. “Medicaid Managed Care penetration rates by state December 31.649. 2001”.