Enabling Investment in Effective Social Interventions: A Review of Medicaid Managed Care Rate‐Setting Tools

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A growing body of research establishes the importance of social interventions to achieving positive health outcomes for vulnerable populations and lowering the costs of care. With the Medicaid expansion bringing millions of adults into managed care plans, it is an ideal time for state Medicaid agencies to work with these plans to ensure a better link between medical and social services. States, however, lack the pricing policy and practices necessary to enable greater investment in social services that affect health outcomes and costs. Building on related Commonwealth Fund–supported work, Deborah Bachrach and her team will assess options to modify Medicaid managed care rate‐setting practices to facilitate sustainable investment in nonmedical services. The team will: 1) review existing rate‐setting methodologies and relevant actuarial guidance; 2) interview Medicaid directors, health plan officials, and actuaries; and 3) develop guidance for states in consultation with an advisory group. The team will partner with actuarial and consulting firm Milliman to identify source materials to inform the analysis of rate‐setting methodologies. This study will inform state and federal Medicaid officials about the options available for financing the provision of social services to the rapidly growing number of beneficiaries enrolled in managed care.

Grant Details

Grantee Organization:
Manatt, Phelps & Phillips, LLP
Principal Investigator:
Deborah Bachrach, J.D.
Award Amount:
$275,019.00
Approval Date:
November 8, 2016

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