Author Archives: Carl Mercurio
IL Medicaid FFS Rate Trends, 2012-17 Data
The data package below provides an historical comparison of Illinois Medicaid fee-for-service rates for 27 top CPT codes for the years 2012 through 2017.
AZ Medicaid FFS Rate Trends, 2012-16 Data
The data package below provides an historical comparison of Arizona Medicaid fee-for-service rates for 27 top CPT codes for the years 2012 to 2016.
MI Medicaid FFS Rate Trends, 2012-17 Data
The data package below provides an historical comparison of Michigan Medicaid fee-for-service rates for 27 top CPT codes for the years 2012 to 2017.
AZ Medicaid Plan Financials, 2016
Arizona Medicaid managed care plans financials are available for the following organizations.
1. Centene/Bridgeway financial report, 2016
2. CMDP financial report, 2016
3 Health Choice Arizona financial report, 2016
4. Maricopa Health Plan financial report, 2016
5. Mercy Care financial report, 2016
6. Phoenix Health Plan financial report, 2016
TX Medicaid Managed Care Capitated Rates, Fiscal 2017
1.Texas Medicaid Managed Care Capitation Rates and Analysis for Children’s Health Insurance Program (CHIP), FY 2017.
2. Medicaid Dental, FY 2017.
3. Medical Transportation Program (MTP), FY 2017.
4. Pharmacy Carve-In, FY 2017.
5. Program of All-Inclusive Care for the Elderly (Pace), FY 2014-17.
6. Star Health Managed Care, FY 2017.
7. Star Managed Care, FY 2017.
8. Star+Plus Managed Care, FY 2017.
9. Supplemental Information for Hospital Rates
AZ Medicaid Managed Care Financial Reports by Plan, 2016
1. Centene/Bridgeway financial report, 2016
2. CMDP financial report, 2016
3 Health Choice Arizona financial report, 2016
4. Maricopa Health Plan financial report, 2016
5. Mercy Care financial report, 2016
6. Phoenix Health Plan financial report, 2016
Market Overview PDF
Download NowDC_110322.pdf
NE Health Plans Await Judge’s Ruling on Medicaid Award Protest
The Omaha World-Herald reported on August 12, 2016, that a U.S. District Judge in Nebraska must soon decide whether to grant a preliminary injunction blocking implementation of the state’s recent Medicaid managed care contract award. Centene, UnitedHealthcare, and WellCare won contracts to serve 233,000 Medicaid managed care members in the state. Aetna and AmeriHealth Caritas have disputed the final award, which was announced in March. After more than three hours of oral arguments on August 11, U.S. District Judge Robert Rossiter took the matter under advisement. Read More
Medicaid Expansion Costs Are Higher than Expected, CMS Says
The Associated Press reported on August 12, 2016, that the cost of expanding Medicaid under the Affordable Care Act was about 49% higher than expected in 2015, according to a report from the Centers for Medicare and Medicaid Services. CMS said the cost of expansion was $6,366 per person in 2015, with sicker-than-expected enrollees and the timing of claims reporting among the possible reasons for the higher cost trends. About 9 million to 10 million people are covered under Medicaid expansion programs in various states. Read More
PMPM Premiums at 10 NY Plans Average $470, 2015 Data
Average per member per month premiums among nine New York Medicaid plans were $470 in 2015. Note: New York’s three largest Medicaid plans – Fidelis Care/NY Catholic Health Plan, HealthFirst and MetroPlus – aren’t required to file financials with NAIC. These three plans combined account for about half of Medicaid managed care membership in the state. Thus, the financials presented here only provide a limited view of the New York Medicaid market.
