Developing a Capitation Analysis for New York’s Dual Eligibles Program

• Provided information to the State, health insurance plans, and other stakeholders on the rate-setting process for establishing FIDA, with the intent to foster health plan participation in the integration process.
• Contracted with Milliman to conduct an actuarial analysis and hosted stakeholder meetings to improve understanding of the rate-setting methodology, assumptions, and decisions related to the development of the FIDA capitation rate, as well as how the rate would differ from the general Medicare and Medicaid populations; and
• Developed two publicly disseminated reports. The first report, “New York Fully Integrated Duals Advantage Program: Perspectives of a Certifying Actuary,” directly impacted the design of the New York State demonstration, which was subsequently expanded to include individuals receiving facility-based long-term supports and services. The second report, “Examination of Medicare A/B Capitation Rates for 2014,” influenced changes made to the rate-setting methodology, which will have a long-term impact on the success of the program and its sustainability in the future.

HPA held a public forum to discuss the proposed methodology, which fostered follow-up conversations with the New York State Department of Health. These discussions resulted in population changes included in FIDA, such as the inclusion of individuals in institutional long-term care. The project provided a platform for robust dialogue among managed care plan representatives and consumer advocates, which led to a common message on the need for premium adequacy.