Funder: West Health Policy Center

Author: Maria Dominiak, Airam Actuarial Consulting, Michelle Herman Soper, Center for Health Care Strategies, and Debra Lipson, Mathematica Policy Research

September 2016 | Technical Assistance Brief


Risk adjusting capitation rates paid to health plans helps ensure more equitable payments to each plan based on expected costs of its enrollees. Several risk-adjustment models exist for plans providing medical services, but currently there is no standardized risk-adjustment model for Medicaid managed long-term services and supports (MLTSS) programs. The development of a standardized, nationally available MLTSS risk-adjustment model for state Medicaid agencies could reduce the burden on states to establish their own models and facilitate comparisons about the key drivers of long-term services and supports (LTSS) costs within and across states. This brief examines considerations in developing a nationally available risk-adjustment model for MLTSS programs. It also explores research needed to develop a robust model that predicts expected LTSS costs as accurately as possible.