Medicaid penetration rate

Try out PMC Labs and tell us what you think. Learn More. To use changes in Medicaid health maintenance organization HMO penetration across markets over time to test for effects on the extent of Medicaid participation among physicians and to test for differences in the effects of increased use of commercial versus Medicaid-dominant plans within the market. Models account for physician, firm, and local characteristics, Medicaid relative payment levels adjusted for geographic variation in practice costs, and market-level fixed effects. There is a positive effect of increases in commercial Medicaid HMO penetration on the odds of accepting new Medicaid patients among all physicians, and in particular, among office-based physicians. In contrast, there is no effect, positive or negative, from expanding the penetration of Medicaid-dominant HMO plans within the market.

This week, our In Focus section reviews preliminary Medicaid spending data collected in the annual CMS Medicaid expenditure report. This figure includes spending on comprehensive risk-based managed care programs as well as prepaid inpatient health plans PIHPs and prepaid ambulatory health plans PAHPs. Fee-based programs such as primary care case management PCCM models are not counted in this total. Below we highlight some key observations:.

The CMS website has two sections that provide Medicare managed care enrollment information that can be used to calculate penetration rates depending on the year s of interest. Information is available at the state, county, and contract level. These reports are updated monthly and many are available for the most current month back to mid

Gettysburg, Pa, Feb. This report provides an overview of the insured population enrolled in managed care plans between and ; the populations examined in the report include those with health insurance through commercial health plans, Medicare, Medicaid, and TRICARE. The report also covers state characteristics of managed care coverage between and , as well as the proportion of managed care enrollees by payer and state.