Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. Appendix B: Tables

07/01/2012

Appendix Table 1: Integration between Medicaid & CHIP Risk-Based Managed Care Programs
Study States CHIP Program Type Contracting Processing the Same Capitation Rates the Same Intentional Contracting with all of the Same Health Plans Quality Monitoring Done The Same Administered by the Same Agency Integration Category for Figure 1

Source: Interviews with state officials.

Notes: (1) Excludes M-CHIP. Annual premium spending of $200+ is considered an indicator of enrollment in a comprehensive risk-based managed care plan. (2) TANF related includes those enrolled in TANF and non-SSI poverty related adults and children.

Arizona Separate x x x x x Fully Integrated
California Combination           Non-Integrated
Connecticut Separate x   x x x Same Contracting Process/Same Plans
Delaware Combination x   x x x Same Contracting Process/Same Plans
Florida Combination           Non-Integrated
Maryland Medicaid Expansion x x x x x Medicaid Expansion
Massachusetts Combination x x x x x Fully Integrated
Michigan Combination         x Non-Integrated
Minnesota Medicaid Expansion x x x x x Medicaid Expansion
New Jersey Combination x x x x x Fully Integrated
New Mexico Medicaid Expansion x x x x x Medicaid Expansion
New York Separate       x x Non-Integrated
Ohio Medicaid Expansion x x x x x Medicaid Expansion
Pennsylvania Separate           Non-Integrated
Rhode Island Medicaid Expansion x x x x x Medicaid Expansion
Tennessee Combination No Risk-Based Managed Care for CHIP  
Texas Separate x     x x Non-Integrated
Virginia Combination       x x Non-Integrated
Washington Separate x x x x x Fully Integrated
Wisconsin Medicaid Expansion x x x x x Medicaid Expansion

 

Appendix Table 2: Enrollment in Comprehensive Risk-Based Managed Care by Population, Age,
and Premium Spending per Enrollee in Study States, 2001–2010
Population Annual Premium Spending 2001 2002 2003 2004 2005 2006 2007 2008
Source: Medical Statistical Information System, data as analyzed by the Urban Institute.
TANF-Related Children, 0–18 $200+ 8,066,530 9,002,211 9,863,270 10,300,518 9,792,777 11,443,596 12,134,827 12,421,974
$1 - $199 1,252,472 1,516,179 1,750,735 2,158,071 1,742,405 2,251,106 2,305,968 2,302,435
$0 4,778,619 4,655,603 4,970,293 5,179,497 3,135,783 4,444,444 3,463,632 3,494,558
Total 14,097,621 15,173,993 16,584,298 17,638,086 14,670,965 18,139,146 17,904,427 18,218,967
TANF-Related Adults, 19–64 $200+ 3,562,013 4,034,708 4,522,326 4,925,755 4,557,851 5,534,074 5,609,745 5,888,751
$1 - $199 576,904 774,515 725,822 854,207 702,012 780,770 848,575 928,866
$0 4,518,237 5,401,340 5,708,322 5,770,149 3,848,267 5,702,396 5,445,033 5,453,200
Total 8,657,154 10,210,563 10,956,470 11,550,111 9,108,130 12,017,240 11,903,353 12,270,817
SSI-Related Children, 0–18 $200+ 304,035 348,049 380,567 386,141 419,763 467,876 524,778 552,918
$1 - $199 72,988 63,058 69,710 76,854 78,498 71,819 80,504 84,062
$0 323,044 295,705 289,470 313,140 259,605 299,422 251,653 257,417
Total 700,067 706,812 739,747 776,135 757,866 839,117 856,935 894,397
SSI-Related Adults, 19–64 $200+ 800,418 874,763 903,692 1,083,570 923,109 1,056,139 1,310,641 1,381,426
$1 - $199 307,727 312,978 335,095 338,966 344,730 342,829 421,596 442,844
$0 987,485 970,364 989,855 1,510,263 781,612 898,775 716,437 770,310
Total 2,095,630 2,158,105 2,228,642 2,932,799 2,049,451 2,297,743 2,448,674 2,594,580
All Populations $200+ 12,732,996 14,259,731 15,669,855 16,695,984 15,693,500 18,501,685 19,579,991 20,245,069
$1 - $199 2,210,091 2,666,730 2,881,362 3,428,098 2,867,645 3,446,524 3,656,643 3,758,207
$0 10,607,385 11,323,012 11,957,940 12,773,049 8,025,267 11,345,037 9,876,755 9,975,485
Total 25,550,472 28,249,473 30,509,157 32,897,131 26,586,412 33,293,246 33,113,389 33,978,761

 

Appendix Table 3: Contracting Approaches for Medicaid and CHIP Managed Care Programs in Study States, 2001–2010
State3 Type (2010)1 Calendar Years of Competitive (RFP)
Procurements in 2001–20102

Source: Review of state documents and interviews with state officials.

1Competitive contracting: not all health plans are necessarily selected to participate; this approach may or may not include a competitive price bid. Any-willing-provider contracting: the state sets a rate, possibly within a rate range, provides contract terms and requirements, and any health plan that meets those requirements is allowed to participate.
2For procurements for Medicaid/CHIP managed care plans occurring between January 1, 2001, and December 31, 2010. Lists the calendar year of the effective date of the new procurement's contract.
3Except for California, Florida, Michigan, and Pennsylvania, all states used the same contracting process for Medicaid and CHIP.

Arizona Competitive 2003, 2008
California    
Medicaid Competitive in some counties Every five years; staggered by counties
CHIP Competitive 2005
Connecticut Competitive 2008, 2009
Delaware Competitive 2003, 2006
Florida    
Medicaid Any Willing Provider N/A
CHIP Competitive 2002, 2006, 2010
Maryland Any Willing Provider N/A
Massachusetts Competitive 2008
Michigan    
Medicaid Competitive 2002, 2004, 2009
CHIP Any Willing Provider N/A
Minnesota Any Willing Provider N/A
New Jersey Any Willing Provider N/A
New Mexico Competitive 2001, 2004, 2007
New York Competitive 2002, 2007
Ohio Competitive 2006 (statewide), 2009 (for some regions)
Pennsylvania    
Medicaid Competitive Every five years; staggered by region
CHIP Any Willing Provider N/A
Rhode Island Competitive 2004, 2010
Tennessee (Medicaid only) Competitive 2007 (Middle), 2008 (West), 2009 (East)
Texas Competitive 2008
Virginia Any Willing Provider One RFP in 2001; since then Any Willing Provider
Washington Competitive 2002
Wisconsin Competitive in one region; Any Willing Provider in rest of state 2010 (for one region)

 

Appendix Table 4: Number and Characteristics of Participating Risk-Based Medicaid Managed Care Plans in 20 States, 2010
State

 

Number of Participating Plans (Comprehensive Medical Service Plans Only)1

 

Total

 

Serves Public Enrollees Only

 

Serves Public and Commercial Enrollees

 

Also participate in CHIP

 

 
Nonprofit For-profit Nonprofit For-profit

Sources: (1) Gifford et al., 2011; (2) Review of state documents.

1Excludes limited-benefit, specialized plans such as those that deliver only behavioral health care, dental care, or long-term care.

Arizona 9 2 2 3 2 9
Connecticut 3 1 0 0 2 3
California 19 13 1 2 3 18
Delaware 2 0 2 0 0 2
Florida 18 1 9 1 7 7
Maryland 7 3 2 2 0 7
Massachusetts 5 2 0 3 0 5
Michigan 9 3 1 3 2 5
Minnesota 8 4 0 4 0 8
New Jersey 4 0 1 2 1 4
New Mexico 4 0 1 2 1 4
New York 21 12 3 6 0 18
Ohio 7 4 1 1 1 7
Pennsylvania 9 1 1 3 4 5
Rhode Island 2 1 0 0 1 2
Tennessee 4 0 1 0 3 0
Texas 14 6 3 2 3 14
Virginia 5 1 1 1 2 5
Washington 7 1 2 4 0 7
Wisconsin 17 1 4 6 6 17
Total 174 56 35 45 38 -
Percent 100.0 32.2 20.1 25.9 21.8 -

 

Appendix Table 5: Number and Characteristics of Participating Risk-Based CHIP Managed Care Plans
in Selected States, 2010
State Number of Participating Plans (Comprehensive Medical Service Plans Only)1
Total Serves Public Enrollees Only Serves Public and Commercial Enrollees Also participate in Medicaid

Nonprofit

For-Profit

Nonprofit

For-Profit

Source: Review of state documents.
1Excludes limited-benefit, specialized plans such as those that deliver only behavioral health care, dental care, or long-term care.
California 21 15 1 1 4 18
Florida 9 3 2 2 2 7
Michigan 9 2 2 3 2 5
New York 19 9 3 6 1 18
Pennsylvania 9 1 1 3 4 5
Texas 15 6 3 3 3 14
Virginia 5 1 1 1 2 5
Total 87 37 13 19 18 -
Percent 100.0 42.5 14.9 21.8 20.7 -

 

Appendix Table 6: Provider Network/Access Contractual Requirements in Study States, 2010
  Appointment Wait Times Maximum Number of Enrollees to Each Provider Required Geographic Proximity for PCPs
State Routine Care (days) Urgent Care (days) Urban Areas (miles) Rural Areas (miles)

Source: Review of state model contracts.

* These contracts specify that a PCP must be available to serve Medicaid patients 40 hours a week in order to qualify. Providers who are available for a fraction of the time will qualify as a fraction of a participating provider.

Arizona 21 2 No Standard 5 No Standard
Connecticut 10 2 No standard 15 15
California          
Medicaid No Standard 2 1,200* 10 10
CHIP 10 2-4 1,200 15 15
Delaware 21 2 2,500* 30 30
Florida          
Medicaid 7 1 1,500* 30 mins 60 mins
CHIP 28 1 No Standard 20 mins 20 mins
Maryland 30 2 2,000 10 30
Massachusetts 45 2 1,500 15 15
Michigan          
Medicaid No Standard No Standard 750 30 30
CHIP No Standard No Standard No Standard No Standard No Standard
Minnesota 45 1 No 30 30
New Jersey 28 1 2,000* 15 15
New Mexico 30 No Standard 1,500 30 45
New York          
Medicaid 28 1 1,500 30 No Standard
CHIP 28 1 1,500 30 mins 30 mins
Ohio 42 1 2,000 20 45
Pennsylvania          
Medicaid 30 1 No Standard 30 mins 60 mins
CHIP No Standard No Standard 2,000 20 45
Rhode Island 30 1 1,500 No Standard No Standard
Tennessee 21 2 2,500 20 30
Texas          
Medicaid 14 1 No Standard 30 30
CHIP 14 1 No Standard 30 30
Virginia          
Medicaid 30 1 1,500 15 30
CHIP 14 1 1,500* 30 60
Washington 10 2 No Standard 10 25
Wisconsin No Standard 1 No Standard 20 20

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