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

October 27, 2015

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.