Risk adjusting for Medicaid participation in Medicare Advantage.

ABSTRACT:

Objectives

Determining appropriate capitated payments has important access implications for dual-eligible Medicare Advantage (MA) members. In 2017, MA plans began receiving higher capitated payments for beneficiaries with full vs partial Medicaid when payments started being risk adjusted for level of Medicaid benefits instead of any Medicaid participation. This approach could favor MA plans in states with more generous Medicaid programs where more beneficiaries qualify for full Medicaid and thus a higher capitated payment. To understand this issue, we examined adjusted Medicare spending for dual-eligible beneficiaries across states with differing Medicaid eligibility criteria.

Study design

Retrospective analysis of 2007-2015 traditional Medicare data for dual-eligible benefi

SUBMITTER: Keohane LM 

PROVIDER: S-EPMC7864213 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature