Medicaid Actuarial Services

This unit provides advanced financial and statistical support for the Bureau relating to Capitation Rates, Risk Adjustment Models and Payment Methodologies.

Unit Responsibilities include:

  • Support of Capitation Rate Development and Adjustment
  • Management of External Actuarial Service Contracts
  • Monitoring Medicaid Program Changes
  • Trend Analysis
  • Rate Impact Analysis

For Institutional Reimbursement rates, please click here.

SMMC Capitation Information

Managed Medical Assistance (MMA)

Long-Term Care (LTC)


Medicare Dual Eligible Special Needs Plans (D-SNPs) and Fully Liable Medicare Advantage Plans

Special Needs Plan Revenue and Expense Schedule Statement Template Tool [157KB Excel]
Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) Medicaid Covered Services [157KB PDF] Effective January 1, 2022
Fully Liable Medicare Advantage Plan Medicaid Covered Services [58KB PDF] Effective July 1