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

567
demographics of the
population enrolled in that Naonal Acadeoy foe State Health Policy
plan. As shown by Chart F32
most states do adjust the rate
C <strong>Medicaid</strong> Maned care
~k-B-d C ctina
based on enrollee
characteristics.
AFDC S9 M
Unfortunately, the
characteristics most states use
Health 80288
H.ith at.
16% -3.
^
do not account for most of
the variation in costs among s.
8%itfiow 16 .- 3
populations that are elderly s. 4_S
or have a disability.33 In sate 2t '>
these cases the cost of caring 2 . l.4
for an individual is more 1: 0%
1 l19
likely to vary by diagnosis,
institutional status, or ability
i-=,
j " 5
to perform activities of daily
living. Since the object of
LI G27hy
adjusting capitation rates is
to bring total payment in line
Sen .8
with the cost of caring for A A14
7.%
enrolled individuals it will 2 uS 1_3
be important for states to D6% 70% 50% %00%
continue to find ways to
adjust rates based on these
more significant factors.
Percent of States
This may mean significant changes to state systems that are not designed to capture
this information-much less make payments based on these factors. Even
collecting some of this information may be difficult as most states do not have access
to the federally maintained information about disabling conditions for persons with
disabilities and the systems that determine eligibility for nursing home placement
are almost always outside the <strong>Medicaid</strong> agency. Some states such as Massachusetts
and Maine are beginning to deal with these issues but much work remains to be
done.
32 Charts F and G are based on state reported information and reflect program status as of
June 30, 1996. For more information about an individual state's policies please refer to Volume L.
33 Richard Kronick, Zhiyuan Zhou, and Tony Dreyfus, 'Making Risk Adjustment Work for
Everyone,' Inquiry 32 (Spring, 1995), 41-55.
The National Academy for Slate Health Policy* 0 8/97 IV 64