Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Chapter 4 Traditional Rate-Setting Approach Does Not Address Negative 49
Risk-Adjusted Rates Incentives and Pressures
and Risk-Sharing Can Risk Adjustment and Reinsurance Have Some Impact on 53
Help Reduce Incentives for Favorable Selection or Underservice
Incentivesuto Risk Corridors Have Greatest Impact on Negative Fliiancial 59
Incentives to Incentives
Underserve Disabled
Beneficiaries
Chapter 5 61
Observations,
Conclusions, and
Comments
Appendix Appendix 1: Major Contributors to This Report 66
Tables Table 1. 1: Average <strong>Medicaid</strong> Per-Person Expenditures by 15
Bseneticiary Uroup, IM3
Table 1.2: Comparison of <strong>Managed</strong> <strong>Care</strong> Flexibility Under
Program and Demonstration Waivers
18
Table 2. 1: Enrollment of Disabled Beneficiaries is 17 State
<strong>Medicaid</strong> Prepaid <strong>Managed</strong> <strong>Care</strong> Programs, February 1996
24
Table 2.2: Description of Four State Prepaid Programs Designed
Specifically for Disabled Beneficaries
26
Table 2.3: Extent to Which 17 States Include Severely Disabled
Beneficiaries in <strong>Medicaid</strong> Prepaid <strong>Care</strong> Programs, February 1996
28
Table 2.4: Examples of Barriers States Face in Including Dually
Eligible Beneficiaries in <strong>Medicaid</strong> Prepaid <strong>Managed</strong> <strong>Care</strong>
Programs
31
Table 2.5: Extent to Which 17 States Include Dually Eligible
Beneficiaries in <strong>Medicaid</strong> Prepaid <strong>Care</strong> Programs. February 1996
32
Table 2.6: Status of Additional Approved and Pending
Demonstration Waivers Including Disabled Beneficiaries As of
February 1996
33
Table 4.1: Missouri Saniple Diagnostic Categories and Rate
Adjustments
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Table 4.2: Oregon's Reinsurance Levels and Rates, 1995-97
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