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Tag: Medicaid

5-Slide Series

This edition looks at the progression of capitation contracting in the Medicaid program at the national and state levels. As s a percentage of total Medicaid spending, capitation contracting has grown 31.1% in FFY2013 to 55.9% in FFY2021. National Medicaid spending via capitation was 47% larger than fee-for-service payments during FFY2021. In two states, Iowa and Hawaii, capitation payments represented more than 90% of overall Medicaid expenditures during FFY2021.

5-Slide Series

This edition presents our tabulations of Medicaid pharmacy cost and price trends. Some of our key findings:

Nationwide Medicaid pre-rebate costs per prescription increased at an annual average rate of 5.6% from 2012-2021, led by an 11.9% annual rate of increase for brand drugs. Average costs per brand drugs rose particularly sharply during recent years, rising 56 % (16% per year) from 2018-2021.
Keeping the mix of drugs constant so that price changes could be assessed, we found that drug prices rose 64% across all drugs that were on the market throughout the 2012-2021 timeframe.
During 2021, 52.1% of Medicaid’s pre-rebate prescription drug spending were attributable to medications with an average cost above $1,000 per prescription. This proportion was “only” 21.5% during 2012.

5-Slide Series

This edition quantifies the decrease in Medicaid prescription volume that has occurred during COVID, comparing usage during calendar years 2019, 2020, and 2021. The large decrease that has occurred – 16.4% from 2019 to 2021 on a per covered person basis — is highly concerning regarding its implications regarding the poverty population’s access to needed medications during the pandemic.

5-Slide Series

We were enlisted by the Anthem Public Policy Institute to assess the cost-effectiveness of different states’ approaches to managing Medicaid prescription drug benefit.  States were grouped into five cohorts depending on the degree to which their Medicaid prescriptions are paid for by MCOs or via the fee-for-service (FFS) setting – and by the degree of latitude MCOs have to manage the mix of drugs. We assessed 100% of Medicaid prescriptions across federal fiscal years 2018, 2019, and 2020.

Publication

States that employ Medicaid managed care organizations (MCOs) to pay for prescription drugs outperform states that rely on the fee-for-service (FFS) setting to control drug costs. Despite larger rebates in FFS, MCOs’ effective strategies to encourage…

Publication

The purpose of this study is to assess the impacts of Kentucky’s Medicaid managed care program. The key components of this assessment include:
• Cost impacts of the Medicaid managed care program across the past two decades
• Performance on key quality measures
• Opioid and medication-assisted treatment (MAT) prescription drug usage trends
• Kentucky’s recent experience with COVID-19 vaccinations
• Minimum contract requirements for managed care organizations (MCOs) to participate in Kentucky’s Medicaid program
• Competitive procurement dynamics

5-Slide Series

This edition of our 5 Slide Series examines state Medicaid spending during Federal Fiscal Year 2020. Using expenditure reports from CMS, we calculated the share of each state’s Medicaid spending that occurred via capitation. Capitation represented the majority (52.6%) of nationwide Medicaid expenditures during 2020, followed by fee-for-service claims payments (40.1%) and special financing programs (7.3%). Use of a comprehensive care coordination model centered around capitation contracting has grown sharply throughout the past decade, increasing from 27% of national Medicaid spending during 2010 to 53% in 2020. In 22 states capitation represented a majority of Medicaid spending during 2020.

Publication

The purpose of this study is to compare the US states that have adopted the Affordable Care Act’s (ACA) Medicaid Expansion to the states that have not done so. The Medicaid Expansion makes people with incomes up to 138 percent of the federal poverty (FPL) line eligible for Medicaid. The US Supreme Court ruling in June 2012 made the Medicaid Expansion, originally intended to be nationwide, optional for states. To date, 37 states and the District of Columbia have implemented this Expansion.

We compare a group of states that adopted the Medicaid population, excluding a few states that had, pre-ACA, already covered most or all of this Expansion population, to those states that had not adopted this Expansion through the end of 2019. We compare these groups of states across the Medicaid Expansion timeframe that was available for analysis (typically 2014-2019). Some of the key components of our assessment included:
• Health Coverage — particularly impacts on the size of the uninsured population
• Medicaid Costs – overall and at the state and federal level
• Deaths in the under-65 population
• Employment Levels and Unemployment Rates

This study is an objective analysis of the observed impact of Medicaid Expansion on the number of uninsured, Medicaid costs to both states and the federal government, deaths, employment, hospitals’ financial situation, and other key outcomes. The intent is to help inform the states that have not yet implemented the Expansion about its likely impact, as well as to demonstrate for Expansion states the aggregated impacts that have occurred.

5-Slide Series

This edition of our 5 Slide Series coincides with today’s release of a new report, “Assessment of Medicaid Expansion’s Impacts.”  The 5 Slide Series creates an opportunity for our staff team to contribute to the Medicaid industry outside the boundaries of our project work, and this report represents a more significant effort of that nature. 

Publication

Virginia began implementing a Common Core Formulary within its Medicaid managed care program in 2017 for CCC Plus members and in 2018 for Medallion 4.0 members. The Virginia Association of Health Plans (VAHP) engaged The Menges Group to analyze the fiscal and programmatic impacts of this policy change. Our tabulations indicate that the change to the Common Core Formulary led to increased net (post-rebate) Medicaid costs of $13.2 million during calendar year 2019, including $5.5 million in additional state funds.

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