This report, mandated by the Maryland legislature, was originally intended to be a cost analysis that would provide the basis for a financial subsidy to encourage the expansion of Medicare+Choice plans across Maryland. However, the study took a more comprehensive approach to describe the national and state context in which Medicare+Choice withdrawals were occurring and the impact of the withdrawals on consumers and health care programs.
Managed care organizations may be incurring financial losses from persons with HIV/AIDS. Using a statistical model to examine comorbidities that contribute to the variation in health care costs for enrollees with HIV/AIDS, this study developed an improved methodology for calculating capitation payments for this population.
Each state designs and implements its medical eligibility criteria and processes for nursing facility services based on the state’s interpretation of federal law and regulation. This report examines Maryland’s system for Medicaid-reimbursed nursing facility services and community-based alternatives and provides recommendations for improvement.
This article, published in the Journal of Ambulatory Care Management, describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients.
