Comments on: So there was this poor guy, and then there was this other guy in Paradise Valley. http://www.democraticdiva.com/2010/03/10/so-there-was-this-poor-guy-and-this-other-guy-in-paradise-valley/ because a well-behaved diva rarely makes history Sat, 11 Feb 2012 17:56:55 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Kelis http://www.democraticdiva.com/2010/03/10/so-there-was-this-poor-guy-and-this-other-guy-in-paradise-valley/comment-page-1/#comment-112286 Kelis Wed, 08 Jun 2011 09:14:33 +0000 http://www.democraticdiva.com/?p=1634#comment-112286 At last! Someone who udnertsdans! Thanks for posting! At last! Someone who udnertsdans! Thanks for posting!

]]> By: Appleblossom http://www.democraticdiva.com/2010/03/10/so-there-was-this-poor-guy-and-this-other-guy-in-paradise-valley/comment-page-1/#comment-64507 Appleblossom Thu, 11 Mar 2010 15:58:06 +0000 http://www.democraticdiva.com/?p=1634#comment-64507 How come no one talks about taxing beer? Smoking can kill but so does alcohol consumption. How come no one talks about taxing beer?

Smoking can kill but so does alcohol consumption.

]]> By: Donna http://www.democraticdiva.com/2010/03/10/so-there-was-this-poor-guy-and-this-other-guy-in-paradise-valley/comment-page-1/#comment-64487 Donna Thu, 11 Mar 2010 09:04:18 +0000 http://www.democraticdiva.com/?p=1634#comment-64487 Thank you for the correction, Susan. Thank you for the correction, Susan.

]]> By: Susan http://www.democraticdiva.com/2010/03/10/so-there-was-this-poor-guy-and-this-other-guy-in-paradise-valley/comment-page-1/#comment-64475 Susan Thu, 11 Mar 2010 07:28:54 +0000 http://www.democraticdiva.com/?p=1634#comment-64475 Great piece! I do have one correction, however. Since AHCCCS contracts with private insurance companies like United Healthcare (dba Arizona Physician's IPA) they pay a monthly premium per member to the insurance company (a capitation payment) which then obligates the insurance company to cover all costs and allows them a profit. The insurance carriers have limited risk under this model, as the state "re-insures" them to protect them against high cost members. So while the capitation rates are more than the cost of the actual services used (have to allow profits for the private sector!), they are risk and age adjusted so are usually less than $10K a year for the Medicaid population. This group is primarily women and children who don't use a lot of services. The ALTCS (AZ Long Term Care Services) population is the more expensive group to cover because they require long term care and other high dollar items, so that's closer to being a Cadillac plan. Great piece! I do have one correction, however. Since AHCCCS contracts with private insurance companies like United Healthcare (dba Arizona Physician’s IPA) they pay a monthly premium per member to the insurance company (a capitation payment) which then obligates the insurance company to cover all costs and allows them a profit. The insurance carriers have limited risk under this model, as the state “re-insures” them to protect them against high cost members.

So while the capitation rates are more than the cost of the actual services used (have to allow profits for the private sector!), they are risk and age adjusted so are usually less than $10K a year for the Medicaid population. This group is primarily women and children who don’t use a lot of services. The ALTCS (AZ Long Term Care Services) population is the more expensive group to cover because they require long term care and other high dollar items, so that’s closer to being a Cadillac plan.

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