Diagnostic risk adjustment for Medicaid: the disability payment system.
Date of Pub
Dreyfus, Tony; Lee, Lora; Zhou, Zhiyuan
This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments
to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio
are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment
more feasible than for a general population and more critical to creating health systems for people with disability. The application
of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various
diagnoses. The challenges of implementing adjustment by diagnosis are explored.
Capitation Fee : Adolescence : Adult : Aged : Disability Evaluation : Disabled Persons/classification/statistics & numerical
data : Female : Health Care Costs/statistics & numerical data : Human : Male : Medicaid/economics/organization & administration/statistics
& numerical data : Middle Age : Models, Economic : Rate Setting and Review/methods : Regression Analysis : Risk Management
: Support, Non-U.S. Gov't : Support, U.S. Gov't, Non-P.H.S. : United States