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Medicaid Managed Care
The Medicaid Managed Care dataset uses CMS' state Transformed Medicaid Statistical Information System (T-MSIS) data for Arizona, Michigan, Nevada, and New Mexico to identify various metrics for managed care plans within each state. These metrics are designed to allow users to compare plans in each state across different specialty areas (currently Pediatric Dental, Behavioral Health, and Prenatal OB/GYN). This dataset does not include all available data in T-MSIS but utilized a subset to calculate the individual metrics identified.
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Medi-Cal Managed Care Capitation Rates by Managed Care Plan Models
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The datasets contain reimbursement rates paid to participating County Organized Health Systems, Geographic Managed Care, Regional, Senior Care Act (SCAN), Single Plan, and Two-Plan model counties as well as Program of All-Inclusive Care for the Elderly (PACE) organizations for calendar years 2021-2024.
Medi-Cal Managed Care Capitation Rates – Regional Model/Rural Expansion
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This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in the Regional model, by State Fiscal Year. The Regional Model serves beneficiaries in 28 rural counties: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Inyo, Imperial, Lake, Lassen, Mariposa, Mendocino, Modoc, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba. The Department of Health Care Services (DHCS) contracts with two Commercial plans to provide services in each county. San Benito is the only exception where beneficiaries can choose either the managed care plan or (fee-for-service) Medi-Cal.
Medi-Cal Managed Care Capitation Rates - Geographic Managed Care (GMC)
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Medi-Cal Managed Care Capitation Rates – Geographic Managed Care (GMC) by State Fiscal Year. Medi- Cal managed care health plans in the Sacramento and San Diego counties.
Medi-Cal Managed Care Capitation Rates – County Organized Health Systems (COHS) Model
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This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in the COHS model, by State Fiscal Year. The COHS serve beneficiaries in 22 counties. In the COHS model counties, the Department of Health Care Services (DHCS) contracts with a health plan created by the county Board of Supervisors. In a COHS county, all Medi-Cal members are enrolled in the same managed care health plan.