Managed Care/Contracted Services per capita costs, at an approximate average of $143 per client per month for SFY 2009 through SFY 2011, constituted an average of 41% of DSHS Medical Programs total expenditures during the same time period. As of February 2010, 636,000 of 1,158,000 DSHS medical programs clients were enrolled in a DSHS managed care program.
The dramatic growth (15.8%) in per capita costs between SFY 2007 and SFY 2008 was due to substantial vendor rate increases mandated by the Washington State legislature, which were incorporated into the premiums paid by DSHS to its Healthy Options (HO) plans. After the per capita costs stabilized in SFY 2009, subsequent FFS cost control measures that were also implemented in managed care reduced the per client per month figure by 9.6%, resulting in an average reduction for the SFY 09-11 biennium of -1.4%.
The average per capita Managed Care costs growth rate for the SFY 11-13 biennium is forecasted to increase on average by 2.1%. This, along with a continued movement of clients to managed care is forecasted to increase the percent of Managed Care expenditures to 44%. During the SFY 11-13 biennium, per capita costs will average $148
Changing caseload volumes and mix can also impact per capita costs. However, for Managed Care the data on premiums tracks well with the per capita costs. The Base Rate for the Healthy Options Managed Care program was adjusted downward in 2009, dropping from $155.62 per member per month (pmpm) in January, to $152.59 pmpm for the months February – July 2009. The base rate was further adjusted to $141.13 pmpm for August 2009. Following this, the rate was adjusted to $143.19 pmpm for the months September – December 2009. January 2010 saw the base rate increased to $146.12, and July 2010 resulted in an increase to $148.62, which is the base rate still in effect today.