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
Please view the Institutional Reimbursement rates for more information.
SMMC Capitation Information
Managed Medical Assistance (MMA)
-
2024/2025 MMA Post-Implementation Capitation Rates (February 1, 2025 – September 30, 2025)
[
160 kB
]
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2024/2025 MMA Pre-Implementation Capitation Rates (October 1, 2024 – January 31, 2025)
[
176.9 kB
]
-
2023/2024 MMA Capitation Rates (October 2023 - September 2024)
[
151.5 kB
]
-
2022/2023 MMA Capitation Rates (October 2022 - September 2023)
[
148.6 kB
]
-
2021/2022 MMA Capitation Rates (October 2021 - September 2022)
[
412.9 kB
]
-
2020/2021 MMA Capitation Rates (October 2020 - September 2021)
[
413.6 kB
]
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2019/2020 MMA Capitation Rates (October 2019 - September 2020)
[
449.3 kB
]
-
2018/2019 MMA Capitation Rates (SMMC Implementation - September 2019)
[
395.8 kB
]
Long-Term Care (LTC)
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2024/2025 LTC Post-Implementation Capitation Rates (February 1, 2025 – September 30, 2025)
[
117 kB
]
-
2024/2025 LTC Pre-Implementation Capitation Rates (October 1, 2024 – January 31, 2025)
[
125 kB
]
-
2023/2024 LTC Capitation Rates (October 2023 - September 2024)
[
111.3 kB
]
-
2022/2023 LTC Capitation Rates (October 2022 - September 2023)
[
105.4 kB
]
-
2021/2022 LTC Capitation Rates (October 2021 - September 2022)
[
391.6 kB
]
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2020/2021 LTC Capitation Rates (October 2020 - September 2021)
[
387.6 kB
]
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2019/2020 LTC Capitation Rates (October 2019 - September 2020)
[
389.4 kB
]
-
2018/2019 LTC Capitation Rates (SMMC Implementation - September 2019)
[
386.1 kB
]
Dental
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2024/2025 Dental Post-Implementation Capitation Rates (February 1, 2025 – September 30, 2025)
[
101.9 kB
]
-
2023/2024 Dental Capitation Rates (October 2023 - September 2024)
[
103.5 kB
]
-
2022/2023 Dental Capitation Rates (October 2022 - September 2023)
[
57.3 kB
]
-
2021/2022 Dental Capitation Rates (October 2021 - September 2022)
[
370 kB
]
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2020/2021 Dental Capitation Rates (October 2020 - September 2021)
[
370 kB
]
-
2019/2020 Dental Capitation Rates (October 2019 – September 2020)
[
58.4 kB
]
-
2018/2019 Dental Capitation Rates (SMMC Implementation - September 2019)
[
366.1 kB
]
Medicare Dual Eligible Special Needs Plans (D-SNPs) and Fully Liable Medicare Advantage Plans
Dual Special Needs Plan (DSNP) Financial Reporting Template
[
200.8 kB
]
Updated July 2024
