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)
- 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)
- 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
Medicare Dual Eligible Special Needs Plans (D-SNPs)
Special Needs Plan Revenue and Expense Schedule Statement Template Tool [140KB Excel]