Citation URL: http://www.urban.org/SureshRangarajan

The first nationwide comparison of how much states are paying for Medicaid managed care shows more than a two-fold variation in the rates set by 36 states. Of the 36 states responding to the survey, the highest managed care capitation rates occur in Connecticut, Hawaii, Kentucky, Massachusetts, New Hampshire, New Mexico, Texas, Utah, and the District of Columbia; the lowest rates occur in California, Florida, Georgia, Indiana, Kansas, Nevada, South Carolina, Tennessee, and Wisconsin. Capitation rates refer to the amount per Medicaid enrollee that the state pays to the managed care plan per month. The survey found several reasons why rates vary.

This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate data for Medicaid’s Aid to Families with Dependent Children (AFDC)/Temporary Assistance for Needy Families (TANF) and poverty-related populations and made adjustments to make the data comparable across states. The results show a slightly more than twofold variation in capitation rates among states, caused primarily by fee-for-service spending levels and demographics. There is a very low correlation between the variation in Medicaid rates among states and the variations in Medicare’s adjusted average per capita cost. The data are not sufficient to answer questions about the adequacy of rates but should help to further policy discussions and research. (Health Affairs 1999 May/June; 18(3): 217-227).

Los Angeles County Department of Health Services (LACDHS) is undertaking an ambitious restructuring of its entire health care system. LACDHS is attempting to reduce its emphasis on emergency room and inpatient care by building a system of integrated community-based primary, specialty, and preventive care. This report provides an assessment of the demonstration project. It describes the problems and examines the progress in efforts at financial stabilization and structural reengineering.

This study examines the recent expansion of Medicaid managed care from the perspective of the thirteen states in the Urban Institute's Assessing the New Federalism project. States are moving to managed care for Medicaid both to improve beneficiaries' access and to control the growth in program costs. However, we find that despite dramatic growth in enrollment during this decade, few states are enrolling the elderly or the disabled--the most expensive Medicaid beneficiaries. We also conclude that cost-savings objectives are often at odds with goals of contracting with mainstream plans and protecting safety-net providers.

This study examines the recent expansion of Medicaid managed care from the perspective of the thirteen states in the Urban Institute’s Assessing the New Federalism project. States are moving to managed care for Medicaid both to improve beneficiaries’ access and to control the growth in program costs. This article finds that despite dramatic growth in enrollment during this decade, few states are enrolling the elderly or the disabled – the most expensive Medicaid beneficiaries. It also concludes that cost-savings objectives are often at odds with goals of contracting with mainstream plans and protecting safety-net providers. (Health Affairs 1998 May/June; 17(3):43-63)

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