Payment Policy in Medicaid Managed Care

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June 2011

Medicaid managed care payments vary in amount and complexity depending on the populations served, benefit packages provided, and whether the plans are at risk for the costs of services.

Section D of MACPAC’s June 2011 report primarily focuses on risk-based plans to which states typically make per member per month capitation payments. States use a variety of different approaches for setting payment rates for these risk-based plans, including risk adjustment and risk sharing methodologies. Read more about state approaches to determining managed care payment rates and methods used by states to mitigate plan risk.

Publication Type: Reports to Congress

From: June 2011 Report to Congress: The Evolution of Managed Care in Medicaid

Tags: capitation, full risk managed care, kick payments, limited benefit plans, managed care, payment, primary care case management, rate setting, risk adjustment, risk corridors, supplemental payments, Upper Payment Limit (UPL)