October 27, 2015
HMA Senior Consultant Ellen Breslin prepared the recently released “Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs” 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.