Nationwide Evaluation of Medicaid Competition Demonstrations. Volume 7. Rate Setting

摘要

Medicaid capitation/case management demonstrations in six states (CA, FL, MN, MO, NY, NJ) were implemented in 1982-83 to test alternative strategies for the delivery and financing of health care to Medicaid beneficiaries. The program evaluation examined implementation and operation issues, health care utilization and cost impacts, beneficiary access and satisfaction, quality of care, administrative costs, rate setting, and enrollment choice and biased selection. The final report for the evaluation is contained in eight volumes and supporting appendixes. Volume 7 provides case studies of the rate setting process in each of the demonstration sites, along with the comparison of payment rates to actual use and costs. Appendices include the demonstration rate books and independent actuarial reports on two of the demonstrations. Information for the volume was obtained from rate setting documentation, as well as through interviews and personal communications.