Different options can be used. In Medicaid managed care, Arizona pays plans a blended rate that incorporates nursing home and community based costs but gradually tilts to a greater percentage of community-based costs. In Minnesota, the state pays plans for … Continue reading
This will likely mean in most cases basing provider payments on Medicare rates since experience shows that current Medicaid rates, in many cases have led to critical provider shortages. A paper by United Health Center for Reform reported that approximately 49% … Continue reading
Rates should reflect functional limitations, not just diagnoses. A paper from the Massachusetts Medicaid Policy Institute Risk Adjustment for Dual Eligibles: Breaking New Ground in Massachusetts, describes Massachusetts’ experience including functional status in risk adjusted rates.
Whenever risk-based, capitated models are used, payment structures must encourage appropriate utilization of care and reward the provision of preventive care, intensive transition supports, and home and community-based services. A brief from the Kaiser Family Foundation, People with Disabilities and … Continue reading
While integrating responsibility and payment for all Medicare and Medicaid services into one entity has the potential to improve care coordination and improve the health of dual eligibles, dangers exist. Poorly designed risk-sharing and capitated payment models could lead to … Continue reading