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Tag: Medicaid

5-Slide Series

The April 2014 edition of our five slide series focuses on historical Medicaid expenditure growth. The size of annual Medicaid cost increases do not seem to be driven by fluctuations in the economy or by which party holds the presidency. However, a correlation exists between the degree to which state governments are collectively under Democrat political control and relatively high percentage increases in Medicaid program costs. On a PMPM basis, data indicate an annual average cost increase from 2003-2010 very close to 5.0% for each of three major eligibility groups – children, adults (non-disabled, non-duals), and blind disabled (non-duals).

5-Slide Series

This edition explores the dynamics of optimal coordinated care, in relation to governmental policies/actions and MCO operational activities.  There are several combinations of ways that optimal care coordination programs are not yet being achieved. The construct described may be useful in identifying how a given program can be modified to better yield an optimal setting for facilitating access to needed care, ensuring that the services rendered are as cost-effective as possible, and helping covered populations maintain and improve their health status over the course of their daily lives.  The years ahead create exciting opportunities to widen and strengthen partnerships between state and federal governments and the MCO industry in the Medicaid and Medicare arena.

5-Slide Series

This edition of the Series tabulates state average NCQA quality scores across the health plans that have been rated by NCQA.  Separate averages have been calculated for Medicaid health plans, Medicare plans, and private plans.

5-Slide Series

This edition of the Series focuses on Medicaid MCO quality ratings, working with the data NCQA publishes each year.  These slides calculate average quality scores in each of the 33 states with at least one NCQA-ranked plan.  We also ranked the Medicaid MCOs by how their quality scores compares with the average of the other NCQA-ranked MCOs in their state.

5-Slide Series

This month’s 5-Slide Series examines CMS’ MSIS database to tabulate Medicaid costs across 18 service categories between 2007 and 2010. Capitation as a portion of total Medicaid expenditures increased 6.0 percentage points from 2007-2010. Additionally, capitation spending increased 57% from 2007 ($59 billion) to 2010 ($92 billion).

5-Slide Series

This edition of the 5-Slide Series examines CY 2010 national Medicaid expenditures in the institutional setting. Nursing Homes, ICF/MR, and Mental Health Facilities collectively represented about one-fifth of national Medicaid expenditures. Dual eligibles accounted for 88% of nationwide Medicaid nursing home spending and 37% of all FY2010 Medicaid spending.

5-Slide Series

This edition of our 5-slide series examines Medicaid per capita costs for individuals with disabilities and provides recommendations for how to manage this population. 22.1% of nationwide spending for disabled non-duals was paid via capitation during 2010 (versus 50.2% for TANF). The disabled subgroup has many attributes that are more conducive to use of care coordination than TANF, including a high prevalence of chronic conditions and relatively stable and lasting Medicaid eligibility. The ideal approach adopts an individually tailored “whole person” focus that can address multiple health conditions and flexibly accommodate differing life circumstances.

5-Slide Series

This edition of our 5-slide series portrays dual eligible demographics, showing the number of duals in each state broken out between full duals and partial duals. We also show the percentage mix of duals in each state by gender and by age (65+ vs. under-65), and the rate of increase in the number of duals in each state between 2005 and 2010.

5-Slide Series

This edition provides demographic and cost information in children in foster care state by state along with nationwide totals. On average during 2010, 885,000 foster children were covered by Medicaid. Average Medicaid costs per foster child were $6,476 in 2010, ranging from a low of $3,217 in Washington State to a high of $20,084 in Vermont. Eighteen percent of national Medicaid spending on foster children was paid via capitation to health plans during 2010.

5-Slide Series

This edition of the 5-Slide Series presents the evolution of the capitation model in Medicaid.

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