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Medi-Cal Utilization and Fee-For-Service (FFS) Expenditures

Expenditures for medical care and services administered to Medi-Cal certified eligibles can take many forms, which include capitation payments to managed care health plans, Medicare premiums for low-income dual eligibles, and federal disproportionate share hospital (DSH) payments to safety-net public hospitals.

A significant proportion of total Medi-Cal expenditures are generated through the fee-for-service (FFS) health care delivery system.  FFS providers render services and then submit claims for payment that are adjudicated, processed, and paid (or denied) by the Medi-Cal program’s fiscal intermediary.  The electronic claims records generated by these transactions provide a rich source of data that can be used to analyze the relative cost of different groups within the Medi-Cal population, and/or cost of different services provided to Medi-Cal certified eligibles. The summary tables below are designed to facilitate such analyses.

This page presents the following reports:

  • Trend in Medi-Cal FFS Expenditures;

  • Medi-Cal FFS Expenditures by Aid Category;

  • Medi-Cal FFS Expenditures by Service Category;

  • Medi-Cal FFS Expenditures by Provider Type and County;

  • Medi-Cal FFS Expenditures for Treatment of HIV/AIDS; and

  • Long-Term Services and Supports (LTSS) and Specific State Plan Services by County 

Trend in Medi-Cal FFS Expenditures

This report presents the annual trend in Medi-Cal FFS expenditures by coverage category.

Trend in Medi-Cal FFS Expenditures - Fiscal Year (FY) 2005-06 to FY 2011-12 (PDF) 

Trend in Medi-Cal FFS Expenditures - FY 2005-06 to FY 2011-12 (XLS) 

 Analytic Notes - FFS Expenditures Reports (PDF) 

 

Medi-Cal FFS Expenditures by Provider Type and County

This report presents Medi-Cal FFS expenditures for each available CY by provider type and  county.

FFS Expenditures by Provider type and Provider County - CY2013 (Excel)

  

 

Medi-Cal FFS Expenditures by Aid Category

This report presents Medi-Cal FFS expenditures for each available FY by coverage category and aid category.

Medi-Cal FFS Expenditures by Aid Category - FY 2011-12 (PDF)

Medi-Cal FFS Expenditures by Aid Category - FY 2011-12 (XLS)

Medi-Cal FFS Expenditures by Aid Category - FY 2010-11 (PDF)

Medi-Cal FFS Expenditures by Aid Category - FY 2010-11 (XLS)

Medi-Cal FFS Expenditures by Aid Category - FY 2009-10 (PDF)

Medi-Cal FFS Expenditures by Aid Category - FY 2009-10 (XLS)

Medi-Cal FFS Expenditures by Aid Category - FY 2008-09 (PDF)

Medi-Cal FFS Expenditures by Aid Category - FY 2008-09 (XLS)

Analytic Notes - FFS Expenditures Reports (PDF)

Medi-Cal FFS Expenditures by Service Category

This report presents Medi-Cal FFS expenditures for each available FY by coverage category and service category.

Medi-Cal FFS Expenditures by Service Category - FY 2011-12 (PDF)

Medi-Cal FFS Expenditures by Service Category - FY 2011-12 (XLS)

Medi-Cal FFS Expenditures by Service Category - FY 2010-11 (PDF)

Medi-Cal FFS Expenditures by Service Category - FY 2010-11 (XLS)

Medi-Cal FFS Expenditures by Service Category - FY 2009-10 (PDF)

Medi-Cal FFS Expenditures by Service Category - FY 2009-10 (XLS)

Medi-Cal FFS Expenditures by Service Category - FY 2008-09 (PDF)

Medi-Cal FFS Expenditures by Service Category - FY 2008-09 (XLS)

Analytic Notes - FFS Expenditures Reports (PDF)

 

Medi-Cal FFS Expenditures for Treatment of HIV/AIDS

This report was developed at the request of the HIV Care Branch within the California Department of Public Health, Office of AIDS, to assist counties with budget estimates and the annual Ryan White Part A grant application for the federally defined Eligible Metropolitan Areas (EMAs) in California. This report does not cover Medi-Cal managed care capitation payments or services provided through the managed care delivery system.

This report replaces the former Semi-Annual AIDS-Related expenditure report, which was developed at the direction of CMS Region IX. The report discloses unduplicated user counts and expenditures by EMA, County, and Type of Service for persons who have been treated for HIV/AIDS. As noted above, services provided through Medi-Cal FFS include services to individuals enrolled in Medi-Cal managed care plans if those services have been excluded from Medi-Cal managed care contracts. Please note that selection criteria changes with payments beginning January 1, 2014, where only claims reporting a diagnosis code indicative of HIV/AIDS, or a prescription claim for drugs commonly used for the treatment of HIV/AIDS are included. In reports prior to calendar year 2014, additional claims were selected if the individual had any other claim associated with HIV/AIDS treatment. This methodology change will result in lower reported expenditures, as claims for ancillary services are often billed without a diagnosis code.

FFS (HIV/AIDS) Users and Expenditures - Payment months January through June 2017 (Excel)

FFS (HIV/AIDS) Users and Expenditures - Payment months July through December 2016 (Excel)

FFS (HIV/AIDS) Users and Expenditures - Payment months January through June 2016 (Excel)

FFS (HIV/AIDS) Users and Expenditures - Payment months July through December 2015 (Excel)

FFS (HIV/AIDS) Users and Expenditures - Payment months January through June 2015 (Excel) 

FFS (HIV/AIDS) Users and Expenditures - Payment months July through December 2014 (Excel)

FFS (HIV/AIDS) Users and Expenditures - Payment months January through June 2014 (Excel)

FFS (HIV/AIDS) Users and Expenditures - Payment months July through December 2013 (Excel)

LTSS and Specific State Plan Services by County

The following reports present the total Medi-Cal users or LTSS and specific state plan services in calendar year (CY) 2010 by Aid Category, County and Coverage Category.

   Medi-Cal / Medicare Dual Eligibles - CY 2010 (XLS) 

   Medi-Cal Only (Non-Dual Eligibles) - CY 2010 (XLS)

ADDITIONAL NOTES 

  • The presented cost summaries are divided into four broad categories based on source of coverage and delivery of care model:
    • Certified eligibles receiving care under the FFS model with coverage from the Medi-Cal program only,

    • Certified eligibles receiving care under the managed care model with coverage from the Medi-Cal program only,

    • Certified eligibles receiving care under the FFS model who are dually-eligible for coverage from both the Medicare and Medi-Cal programs,

    • Certified eligibles receiving care under the managed care model who are dually-eligible for coverage from both the Medicare and Medi-Cal programs.

  • FFS costs represent the total cost of care for certified eligibles who received care under the FFS model with coverage from the Medi-Cal program only.
  •  For certified eligibles in managed care health plans, FFS costs represent only those services that the plans are not contractually obligated to provide.  These costs are commonly known as “carve-outs.”
  • Dual eligibles receive primary coverage from the Medicare program, with Medi-Cal serving as the secondary payer responsible only for those services not covered by Medicare.
  • The expenditure totals presented in the above cost summaries reflect only the costs for Medi-Cal FFS services administered by DHCS.

Permissions and Sourcing:

It is recommended that anything taken from this website be attributed to its original source. RASD includes suggested sources with each analytic product presented on this site.

 

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Last modified on: 8/17/2017 3:19 PM