Address correspondence to Jeffrey S. Harman, Ph.D., Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL 32610-0195; e-mail: firstname.lastname@example.org. Christy H. Lemak, Ph.D., is with the Department of Health Management and Policy, University of Michigan, Ann Arbor, MI. Mona Al-Amin, Ph.D., Allyson G. Hall, Ph.D., and R. Paul Duncan, Ph.D., are with the Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL.
Changes in Per Member Per Month Expenditures after Implementation of Florida's Medicaid Reform Demonstration
Version of Record online: 6 JAN 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 3, pages 787–804, June 2011
How to Cite
Harman, J. S., Lemak, C. H., Al-Amin, M., Hall, A. G. and Duncan, R. P. (2011), Changes in Per Member Per Month Expenditures after Implementation of Florida's Medicaid Reform Demonstration. Health Services Research, 46: 787–804. doi: 10.1111/j.1475-6773.2010.01226.x
- Issue online: 3 MAY 2011
- Version of Record online: 6 JAN 2011
- managed care;
- financial analysis
Objective. To determine the impact of Florida's Medicaid Reform Demonstration on per member per month (PMPM) Medicaid expenditures.
Data. Florida Medicaid claims data from the two fiscal years before implementation of the Demonstration (FY0405, FY0506) and the first two fiscal years after implementation (FY0607, FY0708) from two reform counties and two nonreform counties.
Study Design. A difference-in-difference approach was used to compare changes in expenditures before and after implementation of reforms between the reform counties and the nonreform counties.
Data Extraction. Medicaid claims and eligibility files were extracted for enrollees in the reform and nonreform counties and collapsed into monthly amounts (N=16,875,467).
Principal Findings. When examining the entire population, the reforms had little impact on PMPM expenditures, particularly among SSI enrollees. PMPM expenditures for SSI enrollees increased by an additional U.S.$0.35 in the reform counties compared with the nonreform counties and increased by an additional U.S.$2.38 for Temporary Assistance for Needy Families (TANF) enrollees. An analysis that limited the sample to individuals with at least 3 or 6 months of observations pre- and postimplementation, however, showed reduced PMPM expenditures of U.S.$11.15–U.S.$19.44 PMPM for both the SSI and TANF populations.
Conclusions. Although Medicaid reforms in Florida did not result in significant reductions in PMPM expenditures when examining the full population, it does appear that expenditure reductions may be achieved among Medicaid enrollees with more stable enrollment, who have more exposure to managed care activities and may have more health care needs than the overall Medicaid population.