Medicaid HMO 2009-2012 Contract
Capitation Rates

AHCA uses the methodology developed by Milliman and Robertson in FY 00/01 to:

• Establish an upper payment limit as an estimate of the cost of providing care for the HMO population in a fee-for-service setting;
• Set capitation rates less than the upper payment limit;
• Develop rates acceptable to HCFA;
• Provide fair reimbursement to the HMOs;
• Foster an increase in rural HMO participation; and
• Minimize the impact of year-to-year fluctuation.

Medicaid Reform Capitation Rates Effective Sep2011   [123 KB, PDF]
Medicaid Non-Reform Capitation Rates Effective Sep2011   [209 KB, PDF]
Medicaid Non-Reform Capitation Rates 2010-2011 Contract Year [105 KB, PDF] *Effective 9/1/2010
Medicaid Reform Capitation Rates 2010-2011 Contract Year [27 KB, PDF] *Effective 9/1/2010
Medicaid Non-Reform Capitation Rates - effective 11-01-2009 [102 KB, PDF]
Medicaid HMO Non-Reform Capitation Rates-2009-2010 Contract Year  [61 KB, XLS]
Medicaid PSN Non-Reform Capitation Rates-2009-2010 Contract Year  [29 KB, XLS]