Webinar: Medicaid encounter data standards

Join Milliman’s Jeremy Cunningham, Maureen Tressel Lewis, and Paul Houchens for the webinar “Medicaid encounter data standards” on Wednesday, June 1, at 12 pm EST. They will provide an overview of encounter data standards and the implications of the final Medicaid managed care rule for state Medicaid agencies and managed care entities. The webinar follows […]

Milliman webinar: Medicaid pass-through payment guidance

Join Milliman’s Christine Mytelka and Andrew Gaffner for the webinar “Medicaid pass-through payment guidance” on Tuesday, May 24, at 12 pm EST. They will provide an overview of pass-through payment provisions in the new Medicaid managed care regulations. This is the first in a series of Milliman articles and webinars focused on the new Medicaid […]

Pass-through payment guidance in final Medicaid managed care regulations

As managed care has replaced fee-for-service (FFS) in the Medicaid market, states have often sought to replicate fee-for-service supplemental provider payment programs in managed care. Supplemental payment programs, sometimes called upper payment limit (UPL) programs, constitute a major source of revenue for providers in many states. Pass-through payments are the primary mechanism currently used to […]

Adjusting MCO payment method beneficial for Medicaid Managed Long-Term Services and Supports programs

Functional-based risk adjustment (FBRA) may help Medicaid Managed Long-Term Services and Supports (MLTSS) programs improve their members’ quality of life and reduce program costs. This can be realized by adjusting capitation rates paid to managed care organizations (MCOs) based on member risk characteristics and not location of care. In this article, Milliman consultant Michael Cook […]

Medicaid to pay more Medicare Part B costs

Preliminary estimates suggest that Medicare Part B premiums and deductibles will increase for calendar year 2016. As a result, state Medicaid agencies may see sizeable increases in the Medicare Part B premiums and cost-sharing expenditures they pay on behalf of some dual eligibles. This NPR Marketplace article quotes Milliman’s Rob Damler discussing the disproportionate percentage […]

Medicaid expansion: A comparison of two states under Section 1115 demonstration waivers

Section 1115 of the Social Security Act gives the Secretary of the U.S. Department of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of Medicaid and the Children’s Health Insurance Program (CHIP). Both Michigan and Indiana opted to use a Section 1115 demonstration waiver to implement their […]

Milliman releases new analysis of Medicaid managed care administrative costs

Milliman today announced new research into the administrative costs associated with Medicaid managed care plans. These plans have become increasingly popular, which is due to the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) and the continued growth of the managed care delivery system within Medicaid. This information is especially valuable […]

Expansion of ASD treatment to a Medicaid EPSDT benefit

Approximately one in 68 children has been identified with autism spectrum disorder (ASD). In July 2014, the Centers for Medicare and Medicaid Services (CMS) issued a letter to state Medicaid directors advising that treatment for ASD should be considered covered under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Historically, treatment of ASD […]

Fixed offer or competitive bid? Choosing the right Medicaid managed care contracting methodology for your state’s needs

Medicaid revenue to risk-based managed care plans has increased significantly in recent years, and there’s now mounting pressure on state Medicaid agencies to deliver quality care and contain costs. Agencies must consider the long-term stability of their Medicaid programs through changes in population, cost trends, and care practices. How Medicaid contracts are awarded to managed […]

Medicaid risk-based managed care: Analysis of financial results for 2013

Most states require that contracted managed care organizations (MCOs) file annual statements with state insurance regulators. The statements are typically based on a standard reporting structure developed and maintained by the National Association of Insurance Commissioners (NAIC), with prescribed definitions enabling comparisons across reporting entities. This report by Christopher Pettit and Jeremy Palmer provides a summary of […]