Overview
The comprehensive Medicaid Rate Study was conducted by Myers and Stauffer in two phases between 2023 and 2025. Phase One was released in February 2024 and Phase 2 in January 2025. The rate study benchmarked Connecticut Medicaid rates to Medicare and peer states when possible.
A rate study is an important, data driven tool used by many state Medicaid programs to support Medicaid policy makers in the development of rational rate setting methods that support access to services, and quality outcomes for Medicaid members. The rate study also reviewed rate-setting methodologies for provider reimbursement, and developed a road map for the Department to rationalize payment rates, payment methods, and methodological inputs and assumptions across the spectrum of Medicaid covered services. The rate study analysis is intended to be used, in conjunction with other available data collected by the Department, to inform a more thoughtful approach to Medicaid reimbursement.
The Department specified that Phase 1 focus on the provider groups: physician specialists, dentists, and behavioral health services providers. Phase 2 work included recommendations that meet the Department’s goal of rationalizing rates, payment methods, and methodological inputs and assessments across similar services for the remainder of the program not addressed in Phase 1.
Major findings of the study recognized current rate changes are mandated on an isolated case-by-case basis through legislation or funded by specific state budget appropriation. Thus, some areas of the Medicaid program have received significantly more frequent increases without any evidence based assessment of sufficiency of rates by service across the entire program. The rate study recommended the development of a rational rate setting process based on successful strategies implemented in other state Medicaid programs. A rate evaluation process support the Department’s goal of:
- Rationalizing rates and payment methods.
- Develop methodological assessments for member access across the program.
- Develop and refine value-based payment models that improve member outcomes and contain costs.
- Invest resources in enhancing coordination of care and prioritizing services that prevent or reduce disease burden instead of acute disease treatment.
A Medicaid Rate Evaluation Process is:
- A set schedule for regular rate review and adjustment of Medicaid rates paid to all Medicaid providers.
- Formalizes a clear and transparent process for rate determination via public notice, presentation, and public comments on proposed rates or program changes.
- Ensures review of relevant state and national data to inform rate amounts and payment models, with emphasis on models that promote high value services, member access and explores value-based reimbursement when appropriate.
Medicaid Rate Evaluation Process and Schedule
The Department will not be able to implement all rate study recommendations at the same time from an operational, administrative, or a financial perspective. By grouping fee schedules, the Department developed an evaluation schedule to create a transparent and predictable timeline for both the provider community and the Department. The Department is developing the evaluation process and will post more information on implementation on this webpage.