Managed Care Enrollment & Capitation Rates

1,6

State Arizona California Florida Illinois Indiana Kentucky Massachusetts Michigan New York Ohio Pennsylvania Texas West Virginia Wisconsin

Statewide Adjusted Medicaid Managed Care Capitation Rates, 2001 2 3 State CPS National CPS $131.54 $141.42 $137.79 $134.46 $135.82 $126.45 $146.36 $148.32 $164.84 $174.14 $191.95 $192.74 $170.96 $170.96 $105.35 $105.01 $149.41 $143.79 $162.30 $168.07 $132.52 $132.50 $127.63 $129.36 $143.81 $135.49 $132.44 $133.20

State Arizona California Florida Illinois Indiana Kentucky Massachusetts Michigan New York Ohio Pennsylvania Texas West Virginia Wisconsin

Medicaid Managed Care Enrollment as of June 30, 2001 4 5 Medicaid Enrollment Managed Care Enrollment % in Managed Care 549,318 527,674 96.06% 5,487,094 2,870,514 52.31% 1,923,121 1,184,506 61.59% 1,455,621 136,497 9.38% 616,752 433,014 70.21% 607,702 489,711 80.58% 954,841 616,241 64.54% 1,137,599 1,023,264 89.95% 2,803,470 728,709 25.99% 1,293,390 277,617 21.46% 1,369,181 1,037,374 75.77% 1,821,570 753,613 41.37% 264,087 122,230 46.28% 514,658 266,577 51.80%

State Arizona California Florida Illinois Indiana Kentucky Massachusetts Michigan New York Ohio Pennsylvania Texas West Virginia Wisconsin

Medicaid Managed Care Enrollment as of December 31, 2003 4 5 Medicaid Enrollment Managed Care Enrollment % in Managed Care 904,209 808,572 89.42% 6,465,318 3,290,477 50.89% 2,155,628 1,386,363 64.31% 1,791,366 149,395 8.34% 761,889 525,900 69.03% 672,923 619,866 92.12% 928,186 577,947 62.27% 1,322,261 1,315,571 99.49% 3,743,119 2,146,190 57.34% 1,649,598 486,745 29.51% 1,523,605 1,218,887 80.00% 2,653,195 1,101,870 41.53% 296,511 148,128 49.96% 772,282 363,284 47.04%

Notes:

To compare capitation rates, adjustments are configured to account for variations in certain areas. Capitation rate adjustments include modifications for (1) age, sex & region, (2) health status, (3) HIV/AIDS, (4) maternity care, (5) carve-outs , (6) disproportionate-share hospital (DSH) payments, (7) graduate medical education (GME) payments, and (8) reinsurance. The adjustments do not account for a change in rates due to an introduction of new contracts, reinsurance arrangements, unreported variations in carved-out services, and selection bias under voluntary capitation rates. The study includes information for capitated HMO programs for Aid to Families with Dependent Children/Temporary Assistance for Needy Families (AFDC/TANF) and poverty-related eligibility groups; however, the research does not include State Childrens Health Insurance Program (SCHIP) members, the elderly and disabled, and the medically needy.
2

The population weights are based on each states Medicaid population according to 2000-2001 Current Population Survey (CPS).
3

The population weights are based on the national Medicaid population according to 2000-2001 CPS.

The unduplicated Medicaid enrollment statistics consist of members in State health care reform programs that expand eligibility beyond conventional Medicaid eligibility standards.
5

The unduplicated managed care enrollment statistics include members receiving comprehensive and limited benefits. Sources: 6 Holahan, John and Shinobu Suzuki. "Medicaid Managed Care Payment Methods and Capitation Rates in 2001. Health Affairs. 2003; 22: 204-218.
7

Centers for Medicare & Medicaid Services. Medicaid Managed Care penetration rates by state June 30, 2001. Available at http://www.cms.hhs.gov/medicaid/managedcare/mcsten01.pdf
8

Centers for Medicare & Medicaid Services. Medicaid Managed Care penetration rates by state December 31, 2003.