Author Archives: Carl Mercurio
GA Medicaid Managed Care Plans Post Solid Financials, 2016 Data
Georgia Medicaid managed care plans recorded relatively solid financial results in 2016, with an 82.5% average MLR. Membership for the year was down 1%.
CO RCCO Payments Top $143 Million, FY 2016 Data
Payments to Regional Care Collaborative Organizations, primary care medical providers and a statewide data and analytics contractor totaled $143.2 million in fiscal 2016 ended June, up from $83.6 million a year earlier. Primary care medical providers involved in the program receive fee-for-service payments for medical services and per member per month payments for medical home services. RCCOs receive PMPM payments for member care coordination and for primary care provider support.
Medicaid Managed Care Value-Based Purchasing Requirements by State, Jun-17
Medicaid managed care value-based purchasing requirements by state are shown in the attached data package.
Average MLR at 200+ Medicaid Managed Care Plans is 87%, 2016 Data
Average medical loss ratio at more than 200 Medicaid managed care plans nationwide rose 150 basis points to 87% in 2016, according to an HMAIS analysis of health plan financial data. Net underwriting gain fell nearly 70% to $1.2 billion on revenues of $166 billion, a margin of less than 1%. Totals include data from 34 states and DC as reported in NAIC state insurance department regulatory filings. States without full-risk Medicaid managed care or not reporting comparable data are Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Idaho, Maine, Montana, North Carolina, North Dakota, Oklahoma, South Dakota, Vermont, and Wyoming.
OR CCOs Post 90.5% MLR, 9 Months 2016 Data
Through six months of 2016, medical loss ratio among 15 Oregon Coordinated Care Organizations reporting data was 90.5%, up from about 88.1% from full-year 2015. Net income among the 15 plans was $64.6 million on revenues of $3.4 billion. There are 16 CCOs in the state.
NY Medicaid FFS Rates, 2015-17 Data
The data package below provides an historical comparison of New York Medicaid fee-for-service rates for 27 top CPT codes for the years 2015 to 2017.
OH Medicaid FFS Rates, 2015-17 Data
The data package below provides an historical comparison of Ohio Medicaid fee-for-service rates for 27 top CPT codes for the years 2015 to 2017.
MN Medicaid FFS Rate Trends, 2016-17 Data
The data package below contains Minnesota Medicaid fee-for-service rates for 27 top CPT codes for June 2016 and April 2017.
NC Medicaid FFS Rates, 2014-17 Data
The data package below provides an historical comparison of North Carolina Medicaid fee-for-service rates for 27 top CPT codes for the years 2014 to 2017.
FL Medicaid FFS Rate Trends, 2012-17 Data
The data package below provides an historical comparison of Florida Medicaid fee-for-service rates for 27 top CPT codes for the years 2012 to 2017.
