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Office of Program Policy Analysis and Government Accountability

Performance Review of Medicaid Managed Care Options Administered by the Agency for Health Care Administration , Report No. 94-18, December 1994

  • The MediPass option appears to have reduced health care utilization and costs. However, the methodology used to estimate MediPass cost-savings may not provide valid estimates of the cost-savings due to MediPass. Estimates are made by comparing the utilization rates and unit costs of medical services provided to MediPass and traditional fee-for-service clients. However, the methodology does not consider external factors, such as client and geographic differences, that could have a differential effect on MediPass and traditional fee-for-service utilization rates or costs. Nor does the methodology take into account all costs associated with providing services to MediPass clients.
  • The Agency for Health Care Administration's methodology for setting monthly fees for clients served by PHPs does not ensure that payments to PHPs do not exceed the average cost the state pays for providing similar services through fee-for-service providers. In fiscal year 1992-93, the statewide average monthly fee paid to PHPs for Aid to Families with Dependent Children (AFDC) clients was $3.36 or 3.2% higher than the state's average fee-for-service costs for AFDC clients. If the average PHP fee for AFDC clients had been equal to average fee-for-service costs, the state's cost to serve these clients in PHPs may have been reduced by as much as $8.7 million.

Which Government Program Summaries contain related information?

Medicaid Health Care Services
Agency for Health Care Administration

What other OPPAGA-related materials are available?

  • Report No. 01-61 Justification Review: Expected Medicaid Savings Unrealized; Performance, Cost Information Not Timely for Legislative Purposes, published in November 2001.
  • Report No. 01-39 Justification Review: Medicaid Program Integrity Efforts Recover Minimal Dollars, Sanctions Rarely Imposed, Stronger Accountability Needed, published in September 2001.
  • Report No. 97-11 Follow-up Report on Medicaid Managed Care Options, published in October 1997.
  • Report No. 94-47 Follow-up Review of Medicaid Managed Care, published in April 1995.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
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