Paying for Medical and Social Complexity in Massachusetts Medicaid.

ABSTRACT:

Importance

The first MassHealth Social Determinants of Health payment model boosted payments for groups with unstable housing and those living in socioeconomically stressed neighborhoods. Improvements were designed to address previously mispriced subgroups and promote equitable payments to MassHealth accountable care organizations (ACOs).

Objective

To develop a model that ensures payments largely follow observed costs for members with complex health and/or social risks.

Design, setting, and participants

This cross sectional study used administrative data for members of the Massachusetts Medicaid program MassHealth in 2016 or 2017. Participants included members who were eligible for MassHealth's managed care, aged 0 to 64 years, and enrolled for at least 183 days in 20

SUBMITTER: Alcusky MJ 

PROVIDER: S-EPMC10481227 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature