Medicaid Rate Cells for Three States

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Medicaid Rate Cells: South Carolina, Ohio, and Indiana

Various states have different Medicaid rate cells. Some of the rate cells for South Carolina include TANF, SSI, OCWI, DUAL, and KICK. The rate cells for OHIO include CFC, ABD, EXT., AFK, and CFC/EXT. Finally, the rate cells for Indiana include FSW, CIH, and MFP-CIH.

CATEGORIES OF MEDICAID RATE CELLS FOR SOUTH CAROLINA, OHIO, AND INDIANA

1. SOUTH CAROLINA

  • TANF (Temporary Assistance for Needy Families)
This program is time-limited and is targeted at poor families with children to enable them to provide their basic needs. This funding aims at ensuring family consistency. The rate cells are as follows:

-0-2 month old at a capitation cost of $1,834.82 per member.
-3-12 month old at a capitation cost of $137.06 per member.
-Age 1-6 at a capitation cost of $103.66 per member.
-Age 7-13 at a capitation cost of $112.34 per member.
-Age 14-18 Male at a capitation cost of $115.86 per member.
-Age 14-18 female at a capitation cost of $139.07 per member.
-Age 19-44 male at a capitation cost of $191.13 per member.
-Age 19-44 female at a capitation cost of $259.04 per member.
-Age 45+ male & female at a capitation cost of $443.66 per member.

  • SSI (Supplementary Security Income)

The SSI is offered by the Social Security Administration and the monthly limit is $733. It is offered through the Optional State Supplementation Program (OSS) and is aimed at disabled residents who are in licensed community residential care facilities. The amount is aimed at compensating individuals for their living costs. There are different rate cells for adults and children.

  • OCWI (Optional Coverage for Women and Infants)

Provides healthcare services to babies and pregnant women from low-income families. Services covered include family planning, hospital care, doctor visits, prescription drugs, medical transportation, and emergency room services. The capitation cost is $248.50.

  • DUAL

Provides services for applications receiving both Medicare and Medicaid benefits. The capitation cost per member is $66.70.

  • FOSTER CARE-CHILDREN

This provides care to children who are receiving adoption assistance. The capitation rate is $842.63.

  • KICK

This applies to inpatient and outpatient maternity delivery. Some of the services offered include maternity office visits, anesthesia, maternity non-delivery, and maternity radiology. The upper limit covered for each delivery is $6,453.64.

2. OHIO

  • CFC (Covered Families and Children)

This rate cells includes individuals from the ages of 1-64 and covers both females and males.

  • ABD (Aged, Blind, and Disabled)

This is the sconed capitation rate theory of the managed Medicaid program in Ohio and it includes rate cells of ABD<21 and ABD 21+.

  • EXT (Medicaid Rates Extended)

This rate cell has been effective from January 2014. The extension rate was developed based on a blend of ABD adult, and CFC adult managed care experience. It includes rate cells for both females and males aged between 19 and 64.

  • CFC/EXT

This is an extension of the Covered Families and Children category. It includes rate cells of maternity delivery.

  • AFK (Adoption and Foster Kids)

The segment of the population in this category has been covered since January 2017.

3. INDIANA

  • CIH (Community Integration and Habilitation)

CIH provides a waiver which enables individuals to remain in community-based settings and also help in the transition from state-operated facilities to community settings. The support offered by CIH enables individuals to maintain optimum levels of community integration and self-determination. It also includes rates of FHIO, CHIO, CMGT, RSPO which consists of residential habilitation services such as RH20, RH10, and RD1-9.

  • FSW (Family Support Waiver)

This provides a non-residential but limited waiver to patients with developmental disabilities who live in settings with informal supports or with their families. The rate category includes rates of RSPO (respite), FHIO (facility habilitation-individual) and CHIO (community habilitation-individual).

  • MFP-CIH (Money Follows the Person-Community Integration and Habilitation)

This is a Federal grant that is awarded to the state to enable patients to shift from institutional settings to community-based and home-based settings. Another category of people who qualify for this grant are patients with developmental and intellectual disabilities who are in approved institutions and are eligible for care requirements of the CIH (Community Integration and Habilitation). The rate category includes rates of CMGT, FHIO, CHIO, RSPO and (RH10, RH20 and RD1-9).

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