Medicaid Rate Cells for Three States
A total of 14 Medicaid rate cells categories for South Carolina, Ohio, and Indiana are analyzed and presented in the findings section below. Six of those categories were for South Carolina, five for Ohio, and three for Indiana. We retrieved South Carolina’s rates from the state’s department of health and human services – Managed Care Capitation Rate Certification Report. For Ohio, we found a report on Medicaid by the Ohio Association of Health Plans. Equally, for Indiana, we pulled the categories from a report on Indiana Health Coverage Programs published by Medicaid. Read on for full details regarding these categories.
1. SOUTH CAROLINA
South Carolina Medicaid rate cells categories include:
- TANF with 0-2 month old (AH3) cell rates, 3-12 month old (AI3), age 1-6 (AB3), age 7-13 (AC3), age 14-18 Male (AD1), age 14-18 female (AD2), age 19-44 male (AE1), age 19-44 female (AE2), and age 45+ (AF3).
- SSI includes Medicaid rate cells for children (SO3) and adults (SP3).
- OCWI (WG2)
- Foster Care — Children (FG3)
- KICK (MG2/NG2).
Ohio Medicaid rate cells categories include:
- CFC (covered families and children), which includes the following rate cells of “HF/HST M+F <1; HF/HST M+F; HF/HST M+F; HF/HST F; HF/HST M; HF F; HF M; HF M+F; and HST F.”
- ABD (aged, blind, and disabled), which includes rate cells of ABD < 21 and ABD 21+.
- Ext. (extension) includes rate cells of 19-34 F; 35-44 F; 35-44 M; 45-54 F; 45-54 M; 55-64 F; and 55-64 M.
- CFC (covered families and children)/EXT, which includes rate cell of delivery.
- AFK (adoption and foster Kids), which includes rate cell of AFK.
Indiana Medicaid rate cells categories include:
- FSW (family supports waiver), which includes rates of CHIO (community habilitation — individual), FHIO (facility habilitation — individual), and RSPO (respite).
- CIH (community integration and habilitation) waiver, which includes rates of CHIO, FHIO, RSPO, RSPO (residential habilitation services [RH10, RH20, RD1-9]; and CMGT (case management).
- MFP — CIH (money follows the person — community integration and habilitation) grant include rates of CHIO, FHIO, RSPO, [RH10, RH20, RD1-9] (residential habilitation services), and CMGT.
According to Urban Organization, Indiana has 15 rate cells which include M&F 0-11 mo., M&F 1-12, M&F 13-20, F 21+, and M 21+ across 3 regions. In each region, the state provided plan-specific rates; thus, we used a straight average of these plan rates as regional rates and did not weight plan rates by enrollment.
TYPICAL MEDICAID RATE CELLS CATEGORIES
Medicaid rate cells must include childrens, pregnant women, and adults’ categories. The childrens category further includes rate cells of Medicaid ages 0-1, 1-5, 6-18 and separate CHIP. On the other hand, pregnant women include rate cells of Medicaid and CHIP, while the adults’ category includes rate cells of parents and childless adults.