Medicaid Actuarial Services

This unit provides advanced financial and statistical support for the Bureau relating to Capitation Rates, Risk Adjustment Models and Payment Methodologies.

Unit Responsibilities include:

• Support of Capitation Rate Development and Adjustment
• Management of External Actuarial Service Contracts
• Monitoring Medicaid Program Changes
• Trend Analysis
• Rate Impact Analysis

For Institutional Reimbursement rates, please click here.

SMMC Capitation Information

Managed Medical Assistance (MMA)

• 2019/2020 MMA Capitation Rates (October 2019 - September 2020) [395KB PDF]
• 2018/2019 MMA Capitation Rates (SMMC Implementation - September 2019) [396KB PDF]
• Interim MMA Capitation Rates (October 2018 - SMMC Implementation) [382KB PDF]
• 2017/2018 MMA Capitation Rates (October 2017 - September 2018) [433KB PDF]
• 2016/2017 MMA Capitation Rates (September 2016 - September 2017) [259KB PDF]
• 2015/2016 MMA Capitation Rates (September 2015 - August 2016) [88KB PDF]
• 2014/2015 MMA Capitation Rates (July 2014 - August 2015) [300KB PDF]
• 2014 MMA Capitation Rates (May 2014 - June 2014) [84KB PDF]

Long-Term Care (LTC)

• 2019/2020 LTC Capitation Rates (October 2019 - September 2020) [306KB PDF]
• 2018/2019 LTC Capitation Rates (SMMC Implementation - September 2019) [387KB PDF]
• Interim LTC Capitation Rates (October 2018 - SMMC Implementation) [387KB PDF]
• 2017/2018 LTC Capitation Rates (October 2017 – September 2018) [386KB PDF]
• 2016/2017 LTC Capitation Rates (September 2016 - September 2017) [55KB PDF]
• 2015/2016 LTC Capitation Rates (September 2015 - August 2016) [55KB PDF]
• 2014/2015 LTC Capitation Rates (September 2014 - August 2015) [89KB PDF]
• 2013/2014 LTC Capitation Rates (August 2013 - August 2014) [55KB PDF]

Dental

• 2019/2020 Dental Capitation Rates (October 2019 – September 2020) [59KB PDF]
• 2018/2019 Dental Capitation Rates (SMMC Implementation - September 2019) [367KB PDF]

Medicare Dual Eligible Special Needs Plans (D-SNPs)

Special Needs Plan Revenue and Expense Schedule Statement Template Tool [142KB Excel]
Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) Medicaid Covered Services [62KB PDF]