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Review of States’ Methodologies for Assigning Managed Care Organization Payments to Different Medicaid FMAPs

The Federal Government pays its share of a State’s medical assistance expenditures under Medicaid on the basis of the Federal Medical Assistance Percentages (FMAP), which varies depending on the State’s relative per capita income (SSA § 1905(b)). Additionally, certain Medicaid services receive a higher FMAP, including family planning services (90 percent) and services provided through an Indian Health Services facility (100 percent). The FMAPs under the Medicaid program are varied, and the actual services provided are less transparent under a managed care model. Therefore, the burden is on States to create accurate and reasonable methodologies to assign managed care payments to those FMAPs. We will review methodologies for assigning MCO payments to different Medicaid FMAPs, e.g., the regular FMAP, the family planning FMAP, and the Indian Health Services FMAP among others.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Review of States’ Methodologies for Assigning Managed Care Organization Payments to Different Medicaid FMAPs Office of Audit Services W-00-17-31509 2018

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