A Guide to Implementing a Health-Based Risk-Adjusted Payment System for Medicaid Managed Care Programs


This manual, prepared by The Hilltop Institute (as the Center for Health Program Development and Management) under contract with the Centers for Medicare and Medicaid Services (CMS), provides a step-by-step approach for state Medicaid programs implementing health-based risk adjustment for managed care organizations. The guide describes information system, financial, and policy issues states should consider, as well as choices related to selecting and implementing a particular methodology. The manual also discusses approaches taken and challenges encountered by other states.

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