The FY 2024 Texas Medicaid managed care capitation rates are actuarially sound overall, with no material program-wide under- or over-funding detected. Milliman identifies several recommendations to strengthen the rate-setting process and reduce future risk, and notes that CMS…
Milliman concluded that FY2023 capitation rates were actuarially sound, with no program-wide pattern of under- or over-funding, though improvements were recommended in several rate-setting and governance processes.
Cook Children’s Health Plan accurately reported STAR Kids medical and pharmacy expenses in FY 2020 and complied with eligibility requirements for medical and pharmacy claims. However, improvements are needed in reporting shared administrative expenses, particularly those alloc…
The audit identified strengths in some areas but also significant weaknesses that could affect the program's integrity and compliance. The Commission has committed to implementing recommended improvements.
The audit found that while the Health Plan accurately reported medical, administrative, and quality improvement expenses, its pharmacy expense reporting was flawed due to unallowable practices by the Pharmacy Benefit Manager, which could impact Medicaid costs and program integ…
The audit found that the Health and Human Services Commission has made significant progress in establishing processes and controls related to Medicaid managed care contract management, in compliance with Senate Bill 894. However, some planned improvements are still in progress…