Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. Integration between Medicaid and CHIP Risk-Based Managed Care

07/01/2012

Before describing Medicaid and CHIP risk-based managed care in the study states, it is necessary to explain the level of integration between their risk-based managed care programs. This is because in most states they are either completely or highly integrated.

There are several distinct factors that affect the degree to which risk-based managed care in the two programs is distinguishable (see Figure 1). Of the 20 study states, 6 have Medicaid expansion programs for CHIP (Maryland, Minnesota, New Mexico, Ohio, Rhode Island, and Wisconsin), and so the risk-based managed care programs are identical for Medicaid and CHIP enrollees. Tennessee (which has a combination CHIP program) does not have risk-based managed care for CHIP, though it does operate a risk-based program for Medicaid.


Figure 1: Integration between Medicaid and CHIP Risk-Based Managed Care Programs
in Study States, 2010

Keyed map of the United States

Source: Interviews with state officials.

Note: More information on the integration of Medicaid and CHIP risk-based managed care is contained in Appendix B, Table 1.

Figure 1: Integration between Medicaid and CHIP Risk-Based Managed Care Programs in Study States, 2010
State Total Medicaid MCO Enrollment (in thousands) Percent of State Total Medicaid Enrollment Percent of Total U.S. Medicaid MCO Enrollment

Source: Interviews with state officials.

Note: More information on the integration of Medicaid and CHIP risk-based managed care is contained in Appendix B, Table 1.

Arizona 1,210 89.2 4.5
Connecticut 391 58.0 1.5
California 4,079 55.0 15.3
Delaware 142 74.0 0.5
Florida 1,287 45.3 4.8
Maryland 685 73.9 2.6
Massachusetts 513 39.2 1.9
Michigan 1,251 68.1 4.7
Minnesota 477 66.3 1.8
New Jersey 974 95.0 3.6
New Mexico 335 68.0 1.3
New York 3,002 62.5 11.2
Ohio 1,730 85.9 6.5
Pennsylvania 1,222 58.5 4.6
Rhode Island 134 75.3 0.5
Tennessee 1,219 100.0 4.6
Texas 1,698 48.9 6.4
Virginia 527 62.1 2.0
Washington 627 54.2 2.3
Wisconsin 624 54.2 2.3
Subtotal 22,127 61.9 82.7
All Other States 4,613 25.4 17.3
Total U.S. 26,740 49.6 100.0

 


This leaves 13 study states with either a combination CHIP program (California, Delaware, Florida, Massachusetts, Michigan, New Jersey, and Virginia) or a separate CHIP program (Arizona, Connecticut, New York, Pennsylvania, Texas, and Washington). While these 13 states all have some component of CHIP that is officially defined as "separate" from Medicaid, study results show that the risk-based managed care operations are integrated for these separate programs with Medicaid in six states (Arizona, Connecticut, Delaware, Massachusetts, New Jersey, and Washington). In these integrated states the same agency administers risk-based managed care for both CHIP and Medicaid, the contracting process is the same, and the plans are chosen together and are identical for both programs. Further, in all but two of these integrated states (Connecticut and Delaware), the capitation rates paid to plans on behalf of Medicaid and CHIP enrollees are also the same. Consequently, in the remainder of the report, we separately discuss CHIP risk-based managed care for only seven states (California, Florida, Michigan, New York, Pennsylvania, Texas, and Virginia), while findings for the CHIP risk-based managed care programs are generally integrated with those for Medicaid managed care programs in the remaining states.

Table 3: Risk-Based Separate CHIP Managed Care
Enrollment in Selected Study States, 2010
State CHIP MCO Enrollment (in thousands)

Source: MACPAC, 2011.

Note: M-CHIP children are excluded from counts.

California 1,175
Florida 386
Michigan 48
New York 539
Pennsylvania 273
Texas 928
Virginia 75
Total 3,424

Separate CHIP program risk-based managed care enrollment in these seven states is shown in Table 3. In 2010, about 3.4 million children were enrolled in risk-based MCOs in these seven states’ separate CHIP programs. This is 76 percent of all CHIP enrollees in risk-based managed care (MACPAC, 2011). Consequently, the experience of these seven states provides a good picture of how CHIP managed care programs operate when separated from Medicaid.

View full report

Preview
Download

"rpt.pdf" (pdf, 1.42Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®