CMS Issues New Medicaid Rate-Setting Guidance for PACE Programs

CMS published updated guidance in December 2024 on how states should develop and document Medicaid capitation rates for PACE organizations, which provide comprehensive care to elderly enrollees. The white paper explains changes to rate-setting methodology, including how to calculate the "Amount That Would Have Otherwise Been Paid" (AWOP) benchmark and broader implications for Medicaid capitation rate development. This matters for state Medicaid directors and actuaries responsible for setting compliant rates for PACE plans, as well as MCOs and health plans considering or operating PACE programs.

Managed Care · LTSS · Long-Term Care

This is outside commentary from Milliman, not part of Medicaid Monitor's independently scored news coverage.

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