Medicaid HMO 2000/2001 Capitation Rates

AHCA set the following goals for the development of these rates by Milliman and Robertson, Inc.:

  • Establishing an upper payment limit as an estimate of the cost of providing care for the HMO population in a fee-for-service setting;
  • Setting capitation rates less than the upper payment limit;
  • Developing rates acceptable to HCFA;
  • Providing fair reimbursement to the HMOs;
  • Fostering an increase in rural HMO participation; and
  • Minimizing the impact of year-to-year fluctutation.

Capitation rates were created in 4 eligibility groups in these categories:

  • Hospital/Medical
  • Dental
  • Transportation
  • Prescription Drug Rebates.
    These dollars have not been subtracted from the overall rates. A pharmacy cost reduction of 5.29% was achieved for all districts and eligibility categories, to total the legislatively-mandated $11 million reduction. 

A Summary by Age, Eligibility Category, and Area (20 KB .pdf) provides general information about the 2000-2001 Medicaid HMO Capitation Rates. More detailed information is available in the appendices listed below, posted in 2 formats for your convenience.

Self-Extracting Archive File
Zip File
TANF/AFDC (Appendix A)
SSI - No Medicare (Appendix B)
SSI - Medicare A & B (Appendix C)
SSI - Medicare B (Appendix D)

 

 

 

 

 


For self-extracting archives: Double-click on the file name and select "Save this program to disk" to save the file on your hard drive. Double-click the file after download is complete to open the WinZip self-extractor. Click the "browse" button to select a folder on your hard drive in which to save the files, and then hit the "Unzip" button. The files will then be automatically decompressed into Excel-formatted worksheets.
 


Reporting Medicaid Fraud