Author Archives: Carl Mercurio
AZ Medicaid Managed Care Rates by Eligibility Category, 2017-18
The following spreadsheet contains an analysis of Arizona Medicaid managed care plan rates by eligibility category. Per member per month rates in Arizona were $189 in 2018 for traditional Medicaid (aka Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) populations), up 0.4% compared to 2017. Expansion PMPM rate was $379, down 0.2%.
Medicaid Managed Care Rates by Eligibility Category, 2018
The following data packages contain an analysis of state-by-state Medicaid managed care capitated rates by eligibility category. State included to date are: Arizona, District of Columbia, Florida, Indiana, Iowa, Louisiana, Michigan, Minnesota, Missouri, Mississippi, Nebraska, Nevada, New York, Ohio, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, and Wisconsin.
NC Medicaid Managed Care Capitated Rates, 2020
The attached data package analyzes Medicaid managed care rates for North Carolina for 2020.
Medicaid Spending Rises 7.3 Percent in Fiscal 2018, NASBO Says
Reuters reported on November 15, 2018, that Medicaid spending rose 7.3 percent in the fiscal year ending June 30, 2018, compared to a 4.4 percent increase in fiscal 2017, according to National Association of State Budget Officers’ (NASBO) annual state expenditure report. The figures include both state and federal funding for Medicaid, but excludes spending on the Children’s Health Insurance Program, care for the mentally ill or developmentally disabled, and child welfare programs. Federal funds accounted for about 61 percent of Medicaid spending, while state funds accounted for the remainder. Read More
AR Medicaid Annual Overviews, SFY 2013-17
1. Arkansas Medicaid Annual Overview, SFY 2017
2. Arkansas Medicaid Annual Overview, SFY 2016
3. Arkansas Medicaid Annual Overview, SFY 2015
4. Arkansas Medicaid Annual Overview, SFY 2014
5. Arkansas Medicaid Annual Overview, SFY 2013
CA Medicaid Managed Care Plans Generate $46.8 Billion in Premiums, 2017 Data
California Medicaid managed care plans generated revenues of $46.8 billion in 2017, up from $40 billion in 2016, according to an HMAIS analysis of data for 25 plans from the California Department of Managed Health Care (DMHC). Note: some plans are on a calendar year, and some are on a fiscal year. Figures don’t include Gold Coast Health Plan, which doesn’t report financials to DMHC.
Medicaid Drug Spending, Rebates by State, Fiscal 2016 Data
The following data packages from Medpac show Medicaid drug spending by state for fiscal 2016, including Medicaid managed care and fee-for-service expenditures.
1. Gross Medicaid Drug Spending, Rebates by State, Fiscal 2016 Data
2. Gross Medicaid Drug Spending by State, Fiscal 2016 Data
3. Number of Medicaid Prescriptions by State, Fiscal 2016 data
TX Continues to Refine, Expand Medicaid Managed Care Program
On May 2, 2016, Texas received CMS approval for a 15-month extension of its 1115 Waiver through December 2017. The original waiver was approved in 2011 and was set to expire September 2016. The extension includes approval of the continuation of Medicaid managed care, funding for the state’s Uncompensated Care (UC) pool for hospitals providing care to the uninsured, and the Delivery System Reform Incentive Payment (DSRIP) program. HHSC plans to continue discussions with CMS over the term of this extension to secure a longer term extension.
Texas has begun re-procuring contracts for several existing managed care programs. The state issued a request for proposal in February 2017 for CHIP managed care services in the Rural and Hidalgo Service Areas. The RFP will align the CHIP Service Areas with the Medicaid managed care Services Areas, which was required by federal legislation. Contracts for CHIP RSA are currently held by Molina and Centene (Superior).
In September 2017 the state also released a draft RFP for Medicaid managed care contracts for its statewide STAR+PLUS aged, blind, and disabled program, expanding from the previously announced Dallas and Tarrant service areas. The state released a request for information (RFI) for STAR+PLUS in December 2016. Coverage for STAR+PLUS is anticipated to begin January 1, 2019. Texas also anticipates re-procurement of its STAR program to begin around September 2018. STAR serves the state’s TANF population, pregnant women, infants and SSI adults in Medicaid Rural Service Areas and not on Medicare. The state announced in July 2017 that the operational start dates of STAR+PLUS, STAR, and CHIP have all been moved to September 1, 2019 to align the managed care procurement cycles.
Texas continues to transition additional fee-for-service Medicaid recipients into managed care. In June 2017 Texas announced that it intended to award contracts for a new managed care pilot program for individuals with intellectual and developmental disabilities (IIDD) to Molina and United. In December 2015, the state awarded contracts to 10 health plans for STAR Kids, a new Medicaid managed care program aimed at serving 200,000 individuals with disabilities age 21 or younger. Coverage became effective November 1, 2016. However, the state is ending its NorthStar Medicaid behavioral risk carve out.
FL Medicaid Eligibility by County, Age, Sex, Dec-16 Data
Florida Medicaid eligibility by county, age and sex for December 2016 appears in the data packages below.
FL MMA Plan MLRs Decreased by 5% in 2016, Aug-17 Opportunity Assessment
Average MLR among nine MMA Standard Medicaid managed care plans in Florida improved to 86.5% in 2016, down from 92% in 2015.
