Principal Investigator(s)Marian Jarlenski, PhD, MPH
Under federal law, family planning services provided to Medicaid beneficiaries receive 90% federal financial participation (FFP). In order to appropriately claim reimbursement for family planning services provided through managed-care organizations, the Pennsylvania Department of Human Services (DHS) has previously developed a method to determine the proportion of payments to managed-care organizations going to provide family planning services (i.e., family planning factors). However, a number of programmatic and data changes that have occurred in the interim suggest that the method should be updated and refined. More recent data are now available, which will better reflect current patterns of utilization and payments for family planning services. Additionally, adequate data are now available for beneficiaries enrolled in managed care organizations, which will provide more accurate calculations of the family planning factors than extrapolating from beneficiaries in the fee-for-services plans. The project uses enrollment, encounter, inpatient, and pharmacy data for all managed care beneficiaries to update the family planning factors.
The objective of this project is to update and refine the method used to identify the proportion of Medicaid managed-care organization (MCO) expenditures spent on family planning services (i.e., family planning factors). This research uses the most up-to-date data on Pennsylvania Medicaid enrollees to develop updated family planning factors to identify the proportion of MCO expenditures, within each eligibility category, that can receive 90% FFP. A new factor is being developed for the Breast and Cervical Cancer Prevention and Treatment eligibility category. Appropriate methods are being employed to ensure that the new family planning factors are valid and reliable.