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A Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs

Massachusetts Medicaid Policy Institute

HMA Senior Consultant Ellen Breslin prepared this recently released primer for the Massachusetts Medicaid Policy Institute. It includes:

  • An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
  • The overall process for setting Medicaid managed care capitation rates; and
  • The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.


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