Medicaid Managed Care Organizations: Considerations in Calculating Margin in Rate Setting

March 2017

The Society of Actuaries Health Section Research Committee is pleased to make available a research report that describes the components of margin for calculating capitation rates in a Medicaid context along with a description of practical issues that may be encountered by MCO’s. The report includes observations from interviews with MCO executives as well as financial results analysis of MCOs nationwide. The material was authored by Sara Teppema, Jeff Goldman, Luke Smith, and Steve Tutewohl from Valence Health.

Materials

Report

Medicaid Managed Care Organizations Report

Medicaid Managed Care Organizations Appendix 2

Podcast

Thank You

The SOA would like to thank the following individuals for serving on the Project Oversight Group:

Sabrina Gibson, Chair
Christopher Truffer
Don Killian
Kevin Geurtsen
Maria Dominiak
Matthew Varitek
Sudha Shenoy
Rebecca Owen, SOA Health Actuary
Steve Siegel, SOA Research Actuary
Barbara Scott, Sr. Research Administrator

Questions Or Comments?

If you have comments or questions, please send an email to research@soa.org.