Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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APPENDIX 4: Factors Included in Auto-Assignment Algorithms, by StateStateAZ X X X X X XCA X XCOCT X X XDC X X X X XDE X X XFL X X X X XGA X X X X X XHI X X X X XILIN X X X X X X X XKS X X X X X XKY X X XMA X X X X X XMD XMI X X X X XMN X X X XMO X X X X X X X XMS X X XNE X X X X X XNJ X X X XNM X X X XNV X X XNY X X X X XOH X X X X X X X XOR X X X X XPA X X X X XRI XSC X X X X X X XTN X X X X XTX X X X X X XUT X X X X XVA X X X XWA X X X X X XWIRelated <strong>Family</strong>MemberAssignmentGeographicConsiderationsPreviousPlanAssignmentBalancingPlanEnrollmentWV X X XPlanCapacityPrior PCP inNetworkPlan QualityPerformanceEncouragingNewEntrantsOtherPerformanceMeasuresPlan CostTotal 28 24 24 23 15 14 9 5 5 3 6OtherFactorNote: 36 states contract with MCOs. Not all states responded to this survey question.62 00
APPENDIX 5: MCO Capitation Rate-Setting Methods and Pay-for-Performance Strategies, by StateRate-Setting Method Rate Cell Factors Pay-for-Performance StrategiesStateAdministrativeRate Setting UsingActuaries NegotiationCompetitiveBid WithinRate RangesCompetitiveBid AgeEligibilityCategoryHealthStatus Gender Geography OtherCapitationWithhold BonusSharedSavings OtherAZ X X X X X X X XCA X X X X XCO X X X X X X XCT X X X X XDC X X X X XDE X X X X X X XFL X X X X X XGA X X X X XHI X X X X X X XIL X X X X X XIN X X X X X X XKS X X X XKY XMA X X X X X X XMD X X X X X X X XMI X X X X X X X XMN X X X X X X X X X XMO X X X X X X X X XMS X X XNE X X X XNJ X X X X XNM X X XNV X X X X X X X X XNY X X X X X XOH X X X X X X XOR X X X X X XPA X X X X X X X XRI X X X X XSC X X X X X XTN X X X X X X X X X XTX X X X X X X XUT X X X X X X XVA X X X X X XWA X X X X XWI X X XWV X X X X XTotal 27 11 10 5 31 28 22 26 27 4 12 10 1 6Note: 36 states contract with MCOs. Not all states responded to all survey questions.63
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kaisercommission onmedicaidand theu
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kaisercommission onmedicaidand theu
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Table of ContentsExecutive Summary
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EXECUTIVE SUMMARYMedicaid, the publ
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party enrollment brokers to provide
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HEDIS©, CAHPS©, and state-specifi
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ConclusionFor over 30 years, state
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from the recession and the slow rec
Page 18 and 19: A note on Medicaid managed care ter
Page 20 and 21: Managed caremodelTable 1: Medicaid
Page 23 and 24: States are increasingly mandating m
Page 25 and 26: States with Medicaid MCOsKey Sectio
Page 27 and 28: States have “auto-assignment” a
Page 29 and 30: excess of a specified threshold for
Page 31 and 32: Dental care and outpatient and inpa
Page 33 and 34: the second trimester, and within th
Page 35 and 36: eported that they limit PCP panel s
Page 37 and 38: States with non-comprehensive PHPsK
Page 39 and 40: Measuring, monitoring, and improvin
Page 41 and 42: seven states required 10 measures o
Page 43 and 44: CAHPS© surveys. North Carolina is
Page 45 and 46: Special initiatives to improve qual
Page 47 and 48: public health efforts to reduce dis
Page 49 and 50: Medicaid managed long-term care and
Page 51 and 52: (e.g., need to credential Adult <st
Page 53 and 54: In many states, broader efforts foc
Page 55 and 56: Looking ahead: Medicaid managed car
Page 57 and 58: ConclusionFor over 30 years, state
Page 59 and 60: APPENDIX 2: Summary of Medicaid Man
Page 61 and 62: Program Name(e.g., Popular Name, 19
Page 63 and 64: APPENDIX 3: MCO Contracts, Plan Cha
Page 65 and 66: State(No. ofcontracts)NameEnrollmen
Page 67: State(No. ofcontracts)NameEnrollmen
Page 71 and 72: APPENDIX 7: MCO Network Adequacy Re
Page 73 and 74: State Primary Care Obstetric Care S
Page 75 and 76: APPENDIX 9: Providers Recognized as
Page 77 and 78: APPENDIX 11: PCCM Administrative Se
Page 79 and 80: APPENDIX 13: Initiatives to Improve
Page 81 and 82: I. MANAGED CARE OVERVIEW1. Total Ma
Page 83 and 84: 4. Enrollment Requirements.a. We ar
Page 85 and 86: ii. Please indicate whether the fac
Page 87 and 88: c. Required Providers: We are inter
Page 89 and 90: IV. NON-COMPREHENSIVE PREPAID HEALT
Page 91 and 92: . Does your state use CAHPS© surve
Page 93 and 94: VI. SPECIAL INITIATIVESAll states s
Page 95 and 96: Appendix I: Managed Care Contracts1
Page 97: Appendix II: Clinical Quality Perfo
Page 100: 1330 G S T R E E T NW, W A S H I N
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