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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for California for 2007
110 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
69,912,128 |
11,809,343 |
8,885,009 |
9,343,670 |
99,950,150 |
| 1b. Fee-for-Service revenue for Services |
52,778,007 |
46,400 |
5,596,275 |
1,010,724 |
59,431,406 |
| 1. Total revenue for Services (Lines
1a + 1b) |
122,690,135 |
11,855,743 |
14,481,284 |
10,354,394 |
159,381,556 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
72,296,905 |
113,301 |
|
|
72,410,206 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
10,908,742 |
154,321 |
|
|
11,063,063 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
6,174,235 |
61,777 |
949,657 |
1,300,209 |
8,485,878 |
| 3d. Penalties or paybacks to managed
care plans |
1,002,443 |
0 |
326 |
0 |
1,002,769 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
211,067,574 |
12,185,142 |
15,430,615 |
11,654,603 |
250,337,934 |
| Expenses |
| 5a. Capitation expenses for Services |
117,276,363 |
11,223,765 |
14,026,188 |
15,141,168 |
157,667,484 |
| 5b. Fee-for-Service expenses for Services |
82,820,789 |
113,602 |
6,566,933 |
1,518,401 |
91,019,725 |
5. Total expenses for Services
(Lines 5a + 5b) |
200,097,152 |
11,337,367 |
20,593,121 |
16,659,569 |
248,687,209 |
7. Total Managed Care Expenses
(Line 5) |
200,097,152 |
11,337,367 |
20,593,121 |
16,659,569 |
248,687,209 |
Surplus / Deficit
(Line 4 - Line 7) |
10,970,422 |
847,775 |
-5,162,506 |
-5,004,966 |
1,650,725 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
5.5% |
7.5% |
- 25.1% |
- 30.0% |
0.7% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
2,735,363 |
32,832 |
538,482 |
428,721 |
3,735,398 |
| 8b. Member months for managed care (fee-for-service) |
1,954,309 |
1,745 |
164,699 |
29,491 |
2,150,244 |
8. Total Member months for managed care
(Lines 8a + 8b) |
4,689,672 |
34,577 |
703,181 |
458,212 |
5,885,642 |
| 9a. Managed Care Encounters (capitated) |
655,890 |
21,127 |
106,112 |
73,375 |
856,504 |
| 9b. Managed Care Encounters (fee-for-service) |
627,422 |
756 |
44,803 |
8,509 |
681,490 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
1,283,312 |
21,883 |
150,915 |
81,884 |
1,537,994 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
239,301 |
2,813 |
46,395 |
36,813 |
325,322 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
174,818 |
146 |
15,990 |
2,496 |
193,450 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
414,119 |
2,959 |
62,385 |
39,309 |
518,772 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
0 |
0 |
0 |
532 |
532 |
| 12. Number of Managed Care Contracts |
237 |
41 |
187 |
172 |
637 |
data as of: 7/22/2008 11:10:07
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