Medicaid Managed Care Encounter Data: What, Why, and Where Next?

Managed care now serves 23 percent of the Medicaid population. With the shift to capitation, the fee-for-service (FFS) billing mechanism that has generated much of the administrative data used in policy planning and research no longer exists. This article provides an overview of the types of encounter data currently being required of plans and the problems and issues with providing and analyzing such data. It is based on a review of documentation and interviews with representatives of nine States and the Health Care Financing Administration (HCFA). The article concludes by providing recommendations for HCFA, States, and plans in creating and improving encounter data systems.