Medicaid and CHIP Managed Care Payment Methods and Spending in 20 States.

摘要

Today, the principal way care is delivered to Medicaid and Children's Health Insurance Program (CHIP) beneficiaries is through managed care organizations, where the state contracts with health plans to provide health care services to enrollees for a capitated, or fixed, rate. The share of Medicaid and CHIP enrollees in managed care has been steadily rising over the past decade and continued growth is expected in the future. Though important policy changes have taken place in Medicaid managed care rate setting over the past decade, scant information is available on how Medicaid managed care programs establish their capitation rates, and even less exists on CHIP managed care rate setting. This report begins to fill that research gap by examining how 20 states establish Medicaid and CHIP managed care capitation rates, and how their approaches to rate setting have changed over the past ten years. It also analyzes how Medicaid managed care spending for four distinct populations (adults and children, with and without disabilities) and capitation rates in CHIP managed care programs vary among states, and how they have changed over time. Findings are based on case study interviews with Medicaid and CHIP stakeholders in the 20 study states and on an analysis of each states data from the summary files of the Medicaid Statistical Information System.