Issues in Setting Medicaid Capitation Rates for Integrated Care Plans

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March 2013 | Managed Care

Chapter 5 of MACPAC’s March 2013 report focuses on several policy and technical issues related to setting appropriate Medicaid capitation rates for integrated care programs serving dually-eligible beneficiaries.

How Medicaid pays managed care plans for dually eligible enrollees is an important issue as more states seek to enroll persons covered by both Medicare and Medicaid in these plans. The approach to setting Medicaid capitation rates for plans participating in these programs will be a key factor in determining whether the initiatives move forward, are sustained over time, and meet expectations for financial savings. Read more about Medicaid capitation rates in integrated care plans.

Publication Type: Reports to Congress

From: March 2013 Report to the Congress on Medicaid and CHIP

Tags: capitation, dually eligible beneficiaries, duals demonstrations, elderly, full risk managed care, long-term services and supports, managed care, people with disabilities, Program of All-Inclusive Care for the Elderly (PACE), rate setting, risk adjustment, risk corridors, special needs plans, supplemental payments