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Mercer Caveats
| Mercer Government |
| State of Missouri |
April 10, 2026
&"Arial"&10&"Arial,Bold"State of Missouri &"Arial"&12 &"Arial"&10
&"Arial" &"Arial"&10 &"Arial"&8
This report covers information sharing for SFY 2028 MO HealthNet Managed Care capitation rates. This report includes multiple exhibits that collectively comprise the appendices referenced in the "SFY 2028 MO HealthNet Managed Care Rate Actuarial Memorandum" dated April 10, 2026.
This report is prepared on behalf of the State of Missouri, and is intended to be relied upon by MO HealthNet Division for use in understanding the SFY 2028 capitation rates and communicating about the SFY 2028 capitation rates with contracted Health Plans and should not be relied upon by third parties. This report should be relied upon only in relation to the "SFY 2028 MO HealthNet Managed Care Rate Actuarial Memorandum" dated April 10, 2026. It should be read in its entirety and in conjunction with the "SFY 2028 MO HealthNet Managed Care Rate Actuarial Memorandum" dated April 10, 2026 and has been prepared under the direction of Elizabeth Gould and Andrew Flygare, who are members of the American Academy of Actuaries and meet its US Qualification Standard for issuing the statements of actuarial opinion herein.
To the best of Mercer’s knowledge, there are no conflicts of interest in performing this work. The suppliers of data are solely responsible for its validity and completeness. We have reviewed the data and information for internal consistency and reasonableness, but we did not audit it. All estimates are based upon the information and data available at a point in time and are subject to unforeseen and random events, and actual experience will vary from estimates.
Mercer expressly disclaims responsibility, liability, or both for any reliance on this communication by third parties or the consequences of any unauthorized use or disclosures other than as mutually contemplated when we were first retained to perform this work.
Appendix A
&"Arial"&10 &"Arial"&12 &"Arial"&10
&"Arial" &"Arial"&10 &"Arial"&8
GP Base Data - Central
| Region: | Central |
| Rating Group: | COA 1; < 1 year (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 100,131 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 3,921 | $ 3,230.54 | $ 1,055.50 | 0.00% | 1.28% | 0.04% | 3,973 | $ 3,230.50 | $ 1,069.50 |
| Inpatient Hospital - BH | 1 | $ 3,611.83 | $ 0.33 | 0.00% | 0.70% | 0.06% | 1 | $ 3,611.83 | $ 0.33 |
| Emergency Room | 954 | $ 767.66 | $ 61.04 | 0.00% | 0.14% | 0.05% | 956 | $ 767.66 | $ 61.16 |
| Outpatient Hospital - PH | 2,707 | $ 349.20 | $ 78.77 | 0.00% | 0.18% | 0.05% | 2,713 | $ 349.21 | $ 78.95 |
| Outpatient Hospital - BH | 12 | $ 372.13 | $ 0.38 | 0.00% | 0.21% | 0.04% | 12 | $ 372.16 | $ 0.38 |
| Physician Services | 14,356 | $ 120.41 | $ 144.05 | 0.00% | 0.14% | 2.92% | 14,819 | $ 120.22 | $ 148.47 |
| Behavioral Health | 12 | $ 129.91 | $ 0.13 | 0.00% | 0.13% | 0.17% | 12 | $ 129.90 | $ 0.13 |
| Dental | 66 | $ 60.82 | $ 0.34 | 0.00% | 0.12% | 0.15% | 66 | $ 60.81 | $ 0.34 |
| Emergency Transportation | 169 | $ 769.21 | $ 10.83 | 0.00% | 0.32% | 0.04% | 169 | $ 769.54 | $ 10.86 |
| Non-Emergency Medical Transportation | 133 | $ 203.83 | $ 2.26 | -0.22% | 0.23% | 0.00% | 134 | $ 203.38 | $ 2.26 |
| Durable Medical Equipment | 357 | $ 200.34 | $ 5.96 | 0.00% | 0.22% | 0.03% | 358 | $ 200.36 | $ 5.97 |
| Optometric Services | 5 | $ 51.01 | $ 0.02 | 0.00% | 0.04% | 0.00% | 5 | $ 51.01 | $ 0.02 |
| Laboratory and X-Ray | 2,929 | $ 28.86 | $ 7.04 | 0.00% | 0.22% | 0.05% | 2,937 | $ 28.86 | $ 7.06 |
| Other Services | 31 | $ 525.71 | $ 1.37 | 0.00% | 0.63% | 0.19% | 32 | $ 526.02 | $ 1.38 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 4,889 | $ 169.19 | $ 68.94 | 0.00% | 0.14% | 0.00% | 4,896 | $ 169.19 | $ 69.03 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Total Medical Services | N/A | N/A | $ 1,436.96 | 0.00% | 0.98% | 0.33% | N/A | N/A | $ 1,455.86 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | Central |
| Rating Group: | COA 1; Children < 21 (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 1,451,714 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 63 | $ 3,810.43 | $ 19.91 | 0.00% | 1.35% | 0.07% | 64 | $ 3,810.36 | $ 20.19 |
| Inpatient Hospital - BH | 85 | $ 1,651.58 | $ 11.77 | 0.00% | 1.32% | 0.05% | 87 | $ 1,651.45 | $ 11.93 |
| Emergency Room | 415 | $ 770.70 | $ 26.67 | 0.00% | 0.15% | 0.06% | 416 | $ 770.68 | $ 26.73 |
| Outpatient Hospital - PH | 1,138 | $ 435.57 | $ 41.31 | 0.00% | 0.15% | 0.06% | 1,141 | $ 435.58 | $ 41.40 |
| Outpatient Hospital - BH | 137 | $ 287.66 | $ 3.28 | 0.00% | 0.15% | 0.07% | 137 | $ 287.67 | $ 3.29 |
| Physician Services | 2,901 | $ 90.56 | $ 21.90 | 0.00% | 0.11% | 4.09% | 3,030 | $ 90.36 | $ 22.82 |
| Behavioral Health | 720 | $ 125.66 | $ 7.54 | 0.00% | 0.12% | 0.23% | 723 | $ 125.64 | $ 7.57 |
| Dental | 3,046 | $ 93.66 | $ 23.78 | 0.00% | 0.13% | 0.00% | 3,050 | $ 93.66 | $ 23.81 |
| Emergency Transportation | 66 | $ 449.80 | $ 2.49 | 0.00% | 0.29% | 0.05% | 67 | $ 449.87 | $ 2.49 |
| Non-Emergency Medical Transportation | 133 | $ 93.01 | $ 1.03 | -0.48% | 0.27% | 0.00% | 133 | $ 92.58 | $ 1.03 |
| Durable Medical Equipment | 258 | $ 164.46 | $ 3.53 | -0.04% | 0.18% | 0.08% | 259 | $ 164.36 | $ 3.54 |
| Optometric Services | 559 | $ 34.71 | $ 1.62 | 0.00% | 0.10% | 0.00% | 560 | $ 34.71 | $ 1.62 |
| Laboratory and X-Ray | 1,472 | $ 28.61 | $ 3.51 | 0.00% | 0.19% | 0.05% | 1,476 | $ 28.61 | $ 3.52 |
| Other Services | 101 | $ 563.14 | $ 4.76 | 0.00% | 0.19% | 0.08% | 102 | $ 563.24 | $ 4.77 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.06% | 0.00% | - 0 | $ 106.15 | $ - 0 |
| FQHC/RHC | 3,140 | $ 120.33 | $ 31.49 | 0.00% | 0.11% | 0.01% | 3,144 | $ 120.34 | $ 31.53 |
| CCBHO | 656 | $ 121.85 | $ 6.66 | 0.00% | 0.08% | 0.00% | 656 | $ 121.85 | $ 6.66 |
| Total Medical Services | N/A | N/A | $ 211.23 | 0.00% | 0.32% | 0.47% | N/A | N/A | $ 212.89 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | Central |
| Rating Group: | COA 1; Adults 21+ (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 206,476 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 256 | $ 2,671.71 | $ 57.04 | 0.00% | 1.24% | 0.07% | 260 | $ 2,671.57 | $ 57.78 |
| Inpatient Hospital - BH | 130 | $ 1,770.81 | $ 19.16 | 0.00% | 1.47% | 0.05% | 132 | $ 1,770.97 | $ 19.45 |
| Emergency Room | 930 | $ 977.22 | $ 75.74 | 0.00% | 0.16% | 0.06% | 932 | $ 977.21 | $ 75.90 |
| Outpatient Hospital - PH | 2,472 | $ 518.29 | $ 106.76 | 0.00% | 0.15% | 0.06% | 2,477 | $ 518.30 | $ 106.99 |
| Outpatient Hospital - BH | 93 | $ 274.25 | $ 2.12 | 0.00% | 0.11% | 0.13% | 93 | $ 274.23 | $ 2.12 |
| Physician Services | 4,477 | $ 118.33 | $ 44.15 | 0.00% | 0.12% | 5.89% | 4,753 | $ 118.17 | $ 46.81 |
| Behavioral Health | 1,223 | $ 89.45 | $ 9.12 | 0.00% | 0.12% | 0.24% | 1,228 | $ 89.45 | $ 9.15 |
| Dental | 1,038 | $ 107.61 | $ 9.31 | 0.00% | 0.15% | 0.01% | 1,039 | $ 107.61 | $ 9.32 |
| Emergency Transportation | 242 | $ 324.67 | $ 6.55 | 0.00% | 0.22% | 0.05% | 243 | $ 324.68 | $ 6.57 |
| Non-Emergency Medical Transportation | 330 | $ 95.80 | $ 2.63 | -0.18% | 0.16% | 0.00% | 331 | $ 95.62 | $ 2.63 |
| Durable Medical Equipment | 511 | $ 106.62 | $ 4.54 | -0.76% | 0.14% | 0.06% | 512 | $ 105.77 | $ 4.51 |
| Optometric Services | 417 | $ 33.03 | $ 1.15 | 0.00% | 0.12% | 0.00% | 417 | $ 33.03 | $ 1.15 |
| Laboratory and X-Ray | 4,780 | $ 32.40 | $ 12.91 | 0.00% | 0.22% | 0.06% | 4,794 | $ 32.40 | $ 12.94 |
| Other Services | 118 | $ 201.40 | $ 1.98 | 0.00% | 0.29% | 0.07% | 119 | $ 201.47 | $ 1.99 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 3,399 | $ 128.15 | $ 36.30 | 0.00% | 0.13% | 0.05% | 3,405 | $ 128.15 | $ 36.37 |
| CCBHO | 741 | $ 145.23 | $ 8.97 | 0.00% | 0.08% | 0.00% | 742 | $ 145.23 | $ 8.98 |
| Total Medical Services | N/A | N/A | $ 398.42 | -0.01% | 0.37% | 0.70% | N/A | N/A | $ 402.66 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | Central |
| Rating Group: | COA 2; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 109,924 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 151 | $ 2,589.24 | $ 32.63 | 0.00% | 1.45% | 0.45% | 154 | $ 2,589.05 | $ 33.25 |
| Inpatient Hospital - BH | 38 | $ 1,933.56 | $ 6.16 | 0.00% | 1.17% | 0.12% | 39 | $ 1,935.36 | $ 6.24 |
| Emergency Room | 823 | $ 895.93 | $ 61.43 | 0.00% | 0.19% | 0.05% | 825 | $ 895.90 | $ 61.58 |
| Outpatient Hospital - PH | 4,929 | $ 347.77 | $ 142.86 | 0.00% | 0.19% | 0.06% | 4,941 | $ 347.77 | $ 143.20 |
| Outpatient Hospital - BH | 69 | $ 215.82 | $ 1.24 | 0.00% | 0.13% | 0.11% | 69 | $ 215.82 | $ 1.25 |
| Physician Services | 6,571 | $ 98.76 | $ 54.08 | 0.00% | 0.15% | 5.54% | 6,951 | $ 98.68 | $ 57.16 |
| Behavioral Health | 660 | $ 113.06 | $ 6.22 | 0.00% | 0.11% | 0.29% | 663 | $ 113.08 | $ 6.24 |
| Dental | 1,196 | $ 134.18 | $ 13.38 | 0.00% | 0.17% | 0.00% | 1,199 | $ 134.16 | $ 13.40 |
| Emergency Transportation | 171 | $ 335.62 | $ 4.77 | 0.00% | 0.31% | 0.06% | 171 | $ 335.65 | $ 4.79 |
| Non-Emergency Medical Transportation | 297 | $ 96.20 | $ 2.38 | -0.21% | 0.26% | 0.00% | 297 | $ 95.98 | $ 2.38 |
| Durable Medical Equipment | 308 | $ 105.86 | $ 2.71 | -21.47% | 0.26% | 0.06% | 308 | $ 83.19 | $ 2.14 |
| Optometric Services | 386 | $ 33.30 | $ 1.07 | 0.00% | 0.16% | 0.00% | 386 | $ 33.29 | $ 1.07 |
| Laboratory and X-Ray | 8,285 | $ 49.35 | $ 34.07 | 0.00% | 0.26% | 0.10% | 8,317 | $ 49.34 | $ 34.19 |
| Other Services | 10 | $ 81.25 | $ 0.07 | 0.00% | 0.38% | 0.75% | 10 | $ 81.47 | $ 0.07 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 5,075 | $ 132.72 | $ 56.13 | 0.00% | 0.16% | 0.29% | 5,098 | $ 132.72 | $ 56.38 |
| CCBHO | 371 | $ 143.49 | $ 4.44 | 0.00% | 0.09% | 0.00% | 371 | $ 143.49 | $ 4.44 |
| Total Medical Services | N/A | N/A | $ 423.63 | -0.14% | 0.30% | 0.82% | N/A | N/A | $ 427.79 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | Central |
| Rating Group: | COA 5; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 206,699 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 103 | $ 3,349.29 | $ 28.79 | 0.00% | 1.15% | 0.06% | 104 | $ 3,348.98 | $ 29.13 |
| Inpatient Hospital - BH | 50 | $ 1,812.58 | $ 7.58 | 0.00% | 1.21% | 0.07% | 51 | $ 1,812.57 | $ 7.68 |
| Emergency Room | 306 | $ 823.67 | $ 21.03 | 0.00% | 0.12% | 0.06% | 307 | $ 823.65 | $ 21.07 |
| Outpatient Hospital - PH | 1,223 | $ 452.98 | $ 46.16 | 0.00% | 0.15% | 0.06% | 1,225 | $ 452.99 | $ 46.25 |
| Outpatient Hospital - BH | 150 | $ 306.02 | $ 3.83 | 0.00% | 0.12% | 0.11% | 150 | $ 306.01 | $ 3.84 |
| Physician Services | 3,282 | $ 92.04 | $ 25.17 | 0.00% | 0.11% | 3.98% | 3,421 | $ 91.93 | $ 26.21 |
| Behavioral Health | 692 | $ 122.27 | $ 7.05 | 0.00% | 0.11% | 0.26% | 694 | $ 122.27 | $ 7.08 |
| Dental | 2,985 | $ 91.04 | $ 22.65 | 0.00% | 0.13% | 0.00% | 2,989 | $ 91.04 | $ 22.68 |
| Emergency Transportation | 40 | $ 481.07 | $ 1.59 | 0.00% | 0.24% | 0.03% | 40 | $ 481.18 | $ 1.59 |
| Non-Emergency Medical Transportation | 33 | $ 74.77 | $ 0.21 | -75.10% | 1.25% | 0.00% | 33 | $ 18.80 | $ 0.05 |
| Durable Medical Equipment | 233 | $ 177.88 | $ 3.45 | -0.02% | 0.20% | 0.08% | 233 | $ 177.81 | $ 3.46 |
| Optometric Services | 445 | $ 35.28 | $ 1.31 | 0.00% | 0.11% | 0.00% | 446 | $ 35.28 | $ 1.31 |
| Laboratory and X-Ray | 1,461 | $ 31.64 | $ 3.85 | 0.00% | 0.19% | 0.07% | 1,465 | $ 31.64 | $ 3.86 |
| Other Services | 104 | $ 377.41 | $ 3.28 | 0.00% | 0.21% | 0.08% | 105 | $ 377.32 | $ 3.29 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 2,880 | $ 118.57 | $ 28.46 | 0.00% | 0.12% | 0.01% | 2,883 | $ 118.58 | $ 28.49 |
| CCBHO | 531 | $ 122.49 | $ 5.42 | 0.00% | 0.07% | 0.00% | 531 | $ 122.49 | $ 5.42 |
| Total Medical Services | N/A | N/A | $ 209.81 | -0.07% | 0.31% | 0.52% | N/A | N/A | $ 211.41 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | Central |
| Rating Group: | COA 6; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 1,014,161 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 401 | $ 2,551.33 | $ 85.24 | 0.00% | 1.31% | 0.05% | 406 | $ 2,551.39 | $ 86.40 |
| Inpatient Hospital - BH | 202 | $ 1,808.43 | $ 30.39 | 0.00% | 1.38% | 0.05% | 205 | $ 1,808.35 | $ 30.83 |
| Emergency Room | 841 | $ 1,030.57 | $ 72.20 | 0.00% | 0.19% | 0.05% | 843 | $ 1,030.56 | $ 72.37 |
| Outpatient Hospital - PH | 2,411 | $ 561.79 | $ 112.90 | 0.00% | 0.19% | 0.06% | 2,417 | $ 561.79 | $ 113.17 |
| Outpatient Hospital - BH | 98 | $ 313.21 | $ 2.56 | 0.00% | 0.12% | 0.13% | 99 | $ 313.20 | $ 2.57 |
| Physician Services | 4,780 | $ 120.94 | $ 48.17 | 0.00% | 0.15% | 1.01% | 4,835 | $ 120.93 | $ 48.73 |
| Behavioral Health | 1,118 | $ 89.24 | $ 8.31 | 0.00% | 0.14% | 0.21% | 1,122 | $ 89.24 | $ 8.34 |
| Dental | 985 | $ 108.94 | $ 8.94 | 0.00% | 0.17% | 0.00% | 987 | $ 108.94 | $ 8.96 |
| Emergency Transportation | 295 | $ 307.75 | $ 7.57 | 0.00% | 0.30% | 0.05% | 296 | $ 307.77 | $ 7.59 |
| Non-Emergency Medical Transportation | 437 | $ 87.07 | $ 3.17 | -0.16% | 0.28% | 0.00% | 438 | $ 86.92 | $ 3.17 |
| Durable Medical Equipment | 586 | $ 98.24 | $ 4.80 | -0.26% | 0.26% | 0.06% | 588 | $ 97.98 | $ 4.80 |
| Optometric Services | 391 | $ 34.56 | $ 1.13 | 0.00% | 0.14% | 0.00% | 392 | $ 34.56 | $ 1.13 |
| Laboratory and X-Ray | 4,568 | $ 31.05 | $ 11.82 | 0.00% | 0.25% | 0.05% | 4,582 | $ 31.05 | $ 11.86 |
| Other Services | 82 | $ 142.73 | $ 0.98 | 0.00% | 0.29% | 0.12% | 82 | $ 142.73 | $ 0.98 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.15% | 0.00% | - 0 | $ 183.27 | $ - 0 |
| FQHC/RHC | 3,148 | $ 122.86 | $ 32.23 | 0.00% | 0.14% | 0.02% | 3,153 | $ 122.86 | $ 32.28 |
| CCBHO | 788 | $ 140.25 | $ 9.21 | 0.00% | 0.10% | 0.00% | 789 | $ 140.26 | $ 9.22 |
| Total Medical Services | N/A | N/A | $ 439.62 | 0.00% | 0.48% | 0.16% | N/A | N/A | $ 442.40 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | Central |
| Rating Group: | All COAs; Delivery (F) |
| State Fiscal Year: | 2025 |
| Base Deliveries: | 7,327 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPD | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPD |
| Inpatient Hospital - PH | 2,180 | $ 2,502.04 | $ 5,455.43 | 0.00% | 1.28% | 0.00% | 2,208 | $ 2,502.02 | $ 5,525.02 |
| Inpatient Hospital - BH | 1 | $ 2,365.96 | $ 2.59 | 0.00% | 0.53% | 0.00% | 1 | $ 2,365.94 | $ 2.60 |
| Emergency Room | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Outpatient Hospital - PH | 227 | $ 391.22 | $ 88.71 | 0.00% | 0.18% | 0.00% | 227 | $ 391.19 | $ 88.87 |
| Outpatient Hospital - BH | - 0 | $ - 0 | $ 0.03 | 0.00% | 0.00% | 0.00% | - 0 | $ 194.67 | $ 0.03 |
| Physician Services | 2,776 | $ 322.17 | $ 894.24 | 0.00% | 0.14% | 0.00% | 2,779 | $ 322.17 | $ 895.44 |
| Behavioral Health | 9 | $ 162.08 | $ 1.42 | 0.00% | 0.05% | 0.00% | 9 | $ 162.04 | $ 1.42 |
| Dental | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Emergency Transportation | 56 | $ 610.20 | $ 34.09 | 0.00% | 0.28% | 0.00% | 56 | $ 610.19 | $ 34.19 |
| Non-Emergency Medical Transportation | 20 | $ 224.10 | $ 4.38 | 0.00% | 0.15% | 0.00% | 20 | $ 224.14 | $ 4.38 |
| Durable Medical Equipment | 25 | $ 75.11 | $ 1.86 | 0.00% | 0.12% | 0.00% | 25 | $ 75.09 | $ 1.86 |
| Optometric Services | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Laboratory and X-Ray | 642 | $ 49.62 | $ 31.86 | 0.00% | 0.26% | 0.00% | 644 | $ 49.61 | $ 31.94 |
| Other Services | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 102 | $ 151.88 | $ 15.46 | 0.00% | 0.15% | 0.00% | 102 | $ 151.88 | $ 15.48 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Total Medical Services | N/A | N/A | $ 6,530.06 | 0.00% | 1.09% | 0.00% | N/A | N/A | $ 6,601.23 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| &"Arial"&10&"Arial,Bold"State of Missouri | &"Arial"&12&12Appendix A |
| Encounter Base Data Development Exhibit | Final |
&"Arial"&G &"Arial"&10 &"Arial"&8
GP Base Data - East
| Region: | East |
| Rating Group: | COA 1; < 1 year (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 110,754 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 4,295 | $ 3,361.06 | $ 1,203.08 | 0.00% | 1.22% | 0.03% | 4,349 | $ 3,361.16 | $ 1,218.11 |
| Inpatient Hospital - BH | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Emergency Room | 1,173 | $ 878.75 | $ 85.92 | 0.00% | 0.16% | 0.04% | 1,176 | $ 878.72 | $ 86.09 |
| Outpatient Hospital - PH | 1,738 | $ 413.36 | $ 59.88 | 0.00% | 0.18% | 0.04% | 1,742 | $ 413.34 | $ 60.01 |
| Outpatient Hospital - BH | 11 | $ 244.14 | $ 0.23 | 0.00% | 0.23% | 0.03% | 11 | $ 244.12 | $ 0.23 |
| Physician Services | 18,475 | $ 119.43 | $ 183.86 | 0.00% | 0.15% | 3.39% | 19,137 | $ 119.38 | $ 190.38 |
| Behavioral Health | 7 | $ 102.68 | $ 0.06 | 0.00% | 0.12% | 0.18% | 7 | $ 102.66 | $ 0.06 |
| Dental | 57 | $ 62.87 | $ 0.30 | 0.00% | 0.18% | 0.21% | 57 | $ 62.86 | $ 0.30 |
| Emergency Transportation | 156 | $ 373.45 | $ 4.86 | 0.00% | 0.25% | 0.03% | 156 | $ 373.52 | $ 4.87 |
| Non-Emergency Medical Transportation | 207 | $ 64.60 | $ 1.12 | -0.54% | 0.51% | 0.00% | 208 | $ 64.28 | $ 1.12 |
| Durable Medical Equipment | 319 | $ 223.54 | $ 5.94 | 0.00% | 0.24% | 0.02% | 320 | $ 223.49 | $ 5.96 |
| Optometric Services | 5 | $ 51.65 | $ 0.02 | 0.00% | 0.31% | 0.01% | 5 | $ 51.61 | $ 0.02 |
| Laboratory and X-Ray | 2,558 | $ 27.27 | $ 5.81 | 0.00% | 0.31% | 0.02% | 2,566 | $ 27.27 | $ 5.83 |
| Other Services | 42 | $ 276.96 | $ 0.97 | 0.00% | 0.07% | 0.33% | 42 | $ 277.23 | $ 0.97 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,940 | $ 128.93 | $ 20.84 | 0.00% | 0.15% | 0.00% | 1,942 | $ 128.93 | $ 20.87 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Total Medical Services | N/A | N/A | $ 1,572.89 | 0.00% | 0.97% | 0.42% | N/A | N/A | $ 1,594.82 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | East |
| Rating Group: | COA 1; Children < 21 (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 1,659,717 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 113 | $ 4,151.29 | $ 39.21 | 0.00% | 1.27% | 0.04% | 115 | $ 4,151.26 | $ 39.73 |
| Inpatient Hospital - BH | 73 | $ 2,009.72 | $ 12.19 | 0.00% | 1.27% | 0.03% | 74 | $ 2,009.47 | $ 12.35 |
| Emergency Room | 529 | $ 836.52 | $ 36.88 | 0.00% | 0.16% | 0.04% | 530 | $ 836.48 | $ 36.96 |
| Outpatient Hospital - PH | 821 | $ 481.34 | $ 32.93 | 0.00% | 0.18% | 0.03% | 823 | $ 481.33 | $ 33.00 |
| Outpatient Hospital - BH | 130 | $ 292.81 | $ 3.18 | 0.00% | 0.19% | 0.04% | 131 | $ 292.79 | $ 3.19 |
| Physician Services | 3,566 | $ 91.71 | $ 27.25 | 0.00% | 0.14% | 3.56% | 3,703 | $ 91.57 | $ 28.26 |
| Behavioral Health | 746 | $ 113.15 | $ 7.04 | 0.00% | 0.16% | 0.14% | 749 | $ 113.14 | $ 7.06 |
| Dental | 3,690 | $ 97.81 | $ 30.08 | 0.00% | 0.16% | 0.00% | 3,695 | $ 97.82 | $ 30.12 |
| Emergency Transportation | 83 | $ 276.99 | $ 1.91 | 0.00% | 0.33% | 0.03% | 83 | $ 277.02 | $ 1.91 |
| Non-Emergency Medical Transportation | 212 | $ 84.12 | $ 1.49 | -0.47% | 0.39% | 0.00% | 213 | $ 83.75 | $ 1.48 |
| Durable Medical Equipment | 239 | $ 157.36 | $ 3.14 | -0.01% | 0.30% | 0.04% | 240 | $ 157.31 | $ 3.15 |
| Optometric Services | 477 | $ 45.96 | $ 1.83 | 0.00% | 0.15% | 0.00% | 477 | $ 45.96 | $ 1.83 |
| Laboratory and X-Ray | 1,434 | $ 22.56 | $ 2.70 | 0.00% | 0.27% | 0.05% | 1,439 | $ 22.56 | $ 2.71 |
| Other Services | 231 | $ 396.94 | $ 7.65 | 0.00% | 0.34% | 0.03% | 232 | $ 396.93 | $ 7.68 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,406 | $ 101.95 | $ 11.94 | 0.00% | 0.14% | 0.01% | 1,408 | $ 101.95 | $ 11.96 |
| CCBHO | 349 | $ 129.38 | $ 3.76 | 0.00% | 0.10% | 0.00% | 349 | $ 129.38 | $ 3.76 |
| Total Medical Services | N/A | N/A | $ 223.15 | 0.00% | 0.43% | 0.46% | N/A | N/A | $ 225.13 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | East |
| Rating Group: | COA 1; Adults 21+ (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 257,650 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 328 | $ 2,773.30 | $ 75.73 | 0.00% | 1.35% | 0.05% | 332 | $ 2,773.45 | $ 76.78 |
| Inpatient Hospital - BH | 132 | $ 1,999.75 | $ 22.00 | 0.00% | 1.40% | 0.04% | 134 | $ 1,999.48 | $ 22.32 |
| Emergency Room | 990 | $ 998.77 | $ 82.39 | 0.00% | 0.18% | 0.04% | 992 | $ 998.71 | $ 82.58 |
| Outpatient Hospital - PH | 1,756 | $ 524.90 | $ 76.79 | 0.00% | 0.17% | 0.04% | 1,759 | $ 524.89 | $ 76.95 |
| Outpatient Hospital - BH | 45 | $ 371.05 | $ 1.38 | 0.00% | 0.13% | 0.08% | 45 | $ 371.06 | $ 1.38 |
| Physician Services | 4,969 | $ 114.17 | $ 47.27 | 0.00% | 0.15% | 4.66% | 5,213 | $ 114.08 | $ 49.55 |
| Behavioral Health | 1,196 | $ 100.20 | $ 9.99 | 0.00% | 0.14% | 0.18% | 1,200 | $ 100.21 | $ 10.02 |
| Dental | 772 | $ 112.55 | $ 7.25 | 0.00% | 0.18% | 0.01% | 774 | $ 112.56 | $ 7.26 |
| Emergency Transportation | 296 | $ 244.94 | $ 6.05 | 0.00% | 0.29% | 0.04% | 297 | $ 244.95 | $ 6.07 |
| Non-Emergency Medical Transportation | 907 | $ 79.69 | $ 6.02 | -0.10% | 0.36% | 0.00% | 910 | $ 79.60 | $ 6.04 |
| Durable Medical Equipment | 323 | $ 110.20 | $ 2.97 | -0.79% | 0.29% | 0.03% | 324 | $ 109.32 | $ 2.95 |
| Optometric Services | 320 | $ 39.71 | $ 1.06 | 0.00% | 0.17% | 0.00% | 320 | $ 39.71 | $ 1.06 |
| Laboratory and X-Ray | 6,298 | $ 26.70 | $ 14.01 | 0.00% | 0.26% | 0.05% | 6,319 | $ 26.70 | $ 14.06 |
| Other Services | 273 | $ 230.01 | $ 5.23 | 0.00% | 0.28% | 0.03% | 274 | $ 230.05 | $ 5.25 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,518 | $ 107.22 | $ 13.57 | 0.00% | 0.14% | 0.08% | 1,522 | $ 107.22 | $ 13.60 |
| CCBHO | 398 | $ 152.54 | $ 5.06 | 0.00% | 0.09% | 0.00% | 398 | $ 152.54 | $ 5.06 |
| Total Medical Services | N/A | N/A | $ 376.77 | -0.01% | 0.49% | 0.62% | N/A | N/A | $ 380.92 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | East |
| Rating Group: | COA 2; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 116,506 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 224 | $ 2,760.35 | $ 51.60 | 0.00% | 1.33% | 0.29% | 228 | $ 2,760.32 | $ 52.44 |
| Inpatient Hospital - BH | 37 | $ 1,710.07 | $ 5.23 | 0.00% | 1.38% | 0.03% | 37 | $ 1,710.13 | $ 5.30 |
| Emergency Room | 881 | $ 924.79 | $ 67.90 | 0.00% | 0.23% | 0.04% | 884 | $ 924.75 | $ 68.09 |
| Outpatient Hospital - PH | 3,969 | $ 342.72 | $ 113.36 | 0.00% | 0.20% | 0.04% | 3,979 | $ 342.70 | $ 113.63 |
| Outpatient Hospital - BH | 41 | $ 404.97 | $ 1.38 | 0.00% | 0.11% | 0.08% | 41 | $ 404.78 | $ 1.39 |
| Physician Services | 7,392 | $ 100.05 | $ 61.63 | 0.00% | 0.17% | 6.86% | 7,913 | $ 100.05 | $ 65.97 |
| Behavioral Health | 785 | $ 118.65 | $ 7.76 | 0.00% | 0.14% | 0.37% | 789 | $ 118.65 | $ 7.80 |
| Dental | 857 | $ 139.97 | $ 9.99 | 0.00% | 0.19% | 0.01% | 859 | $ 139.96 | $ 10.01 |
| Emergency Transportation | 263 | $ 245.61 | $ 5.37 | 0.00% | 0.34% | 0.04% | 264 | $ 245.63 | $ 5.39 |
| Non-Emergency Medical Transportation | 1,123 | $ 63.42 | $ 5.93 | -0.10% | 0.38% | 0.00% | 1,127 | $ 63.36 | $ 5.95 |
| Durable Medical Equipment | 298 | $ 103.81 | $ 2.58 | -20.84% | 0.42% | 0.03% | 299 | $ 82.27 | $ 2.05 |
| Optometric Services | 331 | $ 39.89 | $ 1.10 | 0.00% | 0.20% | 0.00% | 331 | $ 39.89 | $ 1.10 |
| Laboratory and X-Ray | 11,767 | $ 41.20 | $ 40.40 | 0.00% | 0.28% | 0.10% | 11,815 | $ 41.19 | $ 40.56 |
| Other Services | 42 | $ 177.54 | $ 0.63 | 0.00% | 0.39% | 0.09% | 43 | $ 177.61 | $ 0.63 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 2,502 | $ 117.22 | $ 24.44 | 0.00% | 0.17% | 0.77% | 2,525 | $ 117.24 | $ 24.67 |
| CCBHO | 219 | $ 150.67 | $ 2.75 | 0.00% | 0.10% | 0.00% | 219 | $ 150.67 | $ 2.75 |
| Total Medical Services | N/A | N/A | $ 402.07 | -0.14% | 0.37% | 1.17% | N/A | N/A | $ 407.74 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | East |
| Rating Group: | COA 5; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 220,292 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 118 | $ 3,598.65 | $ 35.40 | 0.00% | 1.45% | 0.03% | 120 | $ 3,597.88 | $ 35.92 |
| Inpatient Hospital - BH | 49 | $ 1,919.55 | $ 7.89 | 0.00% | 1.25% | 0.04% | 50 | $ 1,919.39 | $ 7.99 |
| Emergency Room | 392 | $ 785.66 | $ 25.64 | 0.00% | 0.16% | 0.03% | 392 | $ 785.64 | $ 25.69 |
| Outpatient Hospital - PH | 881 | $ 429.70 | $ 31.54 | 0.00% | 0.17% | 0.04% | 883 | $ 429.69 | $ 31.60 |
| Outpatient Hospital - BH | 166 | $ 288.99 | $ 4.00 | 0.00% | 0.19% | 0.03% | 166 | $ 288.99 | $ 4.01 |
| Physician Services | 3,763 | $ 89.10 | $ 27.94 | 0.00% | 0.14% | 8.59% | 4,101 | $ 88.92 | $ 30.39 |
| Behavioral Health | 828 | $ 107.26 | $ 7.40 | 0.00% | 0.14% | 0.14% | 831 | $ 107.26 | $ 7.42 |
| Dental | 3,371 | $ 92.14 | $ 25.88 | 0.00% | 0.17% | 0.00% | 3,376 | $ 92.14 | $ 25.92 |
| Emergency Transportation | 49 | $ 290.18 | $ 1.19 | 0.00% | 0.31% | 0.03% | 49 | $ 290.24 | $ 1.20 |
| Non-Emergency Medical Transportation | 50 | $ 74.69 | $ 0.31 | -29.42% | 0.74% | 0.00% | 50 | $ 52.85 | $ 0.22 |
| Durable Medical Equipment | 226 | $ 165.65 | $ 3.12 | -0.03% | 0.36% | 0.04% | 227 | $ 165.54 | $ 3.13 |
| Optometric Services | 424 | $ 45.59 | $ 1.61 | 0.00% | 0.14% | 0.00% | 425 | $ 45.59 | $ 1.61 |
| Laboratory and X-Ray | 1,451 | $ 23.27 | $ 2.81 | 0.00% | 0.31% | 0.03% | 1,456 | $ 23.27 | $ 2.82 |
| Other Services | 206 | $ 428.06 | $ 7.34 | 0.00% | 0.30% | 0.02% | 206 | $ 427.93 | $ 7.36 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,203 | $ 103.07 | $ 10.34 | 0.00% | 0.14% | 0.03% | 1,205 | $ 103.07 | $ 10.35 |
| CCBHO | 366 | $ 127.90 | $ 3.90 | 0.00% | 0.10% | 0.00% | 367 | $ 127.90 | $ 3.91 |
| Total Medical Services | N/A | N/A | $ 196.32 | -0.05% | 0.45% | 1.25% | N/A | N/A | $ 199.56 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | East |
| Rating Group: | COA 6; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 1,234,069 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 502 | $ 2,724.89 | $ 114.06 | 0.00% | 1.38% | 0.04% | 509 | $ 2,725.07 | $ 115.68 |
| Inpatient Hospital - BH | 258 | $ 1,947.90 | $ 41.93 | 0.00% | 1.32% | 0.03% | 262 | $ 1,947.93 | $ 42.50 |
| Emergency Room | 878 | $ 1,051.46 | $ 76.90 | 0.00% | 0.19% | 0.04% | 880 | $ 1,051.41 | $ 77.08 |
| Outpatient Hospital - PH | 1,628 | $ 592.00 | $ 80.29 | 0.00% | 0.19% | 0.04% | 1,631 | $ 591.98 | $ 80.48 |
| Outpatient Hospital - BH | 56 | $ 422.03 | $ 1.96 | 0.00% | 0.17% | 0.09% | 56 | $ 422.02 | $ 1.97 |
| Physician Services | 5,056 | $ 118.13 | $ 49.77 | 0.00% | 0.16% | 0.93% | 5,111 | $ 118.12 | $ 50.31 |
| Behavioral Health | 1,182 | $ 96.81 | $ 9.54 | 0.00% | 0.15% | 0.19% | 1,186 | $ 96.82 | $ 9.57 |
| Dental | 694 | $ 113.97 | $ 6.59 | 0.00% | 0.20% | 0.00% | 695 | $ 113.97 | $ 6.60 |
| Emergency Transportation | 363 | $ 240.64 | $ 7.28 | 0.00% | 0.29% | 0.04% | 364 | $ 240.65 | $ 7.30 |
| Non-Emergency Medical Transportation | 823 | $ 72.62 | $ 4.98 | -0.12% | 0.34% | 0.00% | 826 | $ 72.54 | $ 4.99 |
| Durable Medical Equipment | 390 | $ 115.13 | $ 3.74 | -0.19% | 0.26% | 0.04% | 391 | $ 114.88 | $ 3.74 |
| Optometric Services | 292 | $ 41.02 | $ 1.00 | 0.00% | 0.19% | 0.00% | 292 | $ 41.02 | $ 1.00 |
| Laboratory and X-Ray | 5,309 | $ 25.77 | $ 11.40 | 0.00% | 0.28% | 0.04% | 5,326 | $ 25.76 | $ 11.43 |
| Other Services | 98 | $ 221.10 | $ 1.81 | 0.00% | 0.30% | 0.07% | 99 | $ 221.14 | $ 1.82 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ 106.15 | $ - 0 |
| FQHC/RHC | 1,291 | $ 108.56 | $ 11.68 | 0.00% | 0.16% | 0.04% | 1,294 | $ 108.57 | $ 11.71 |
| CCBHO | 485 | $ 145.23 | $ 5.87 | 0.00% | 0.10% | 0.00% | 485 | $ 145.23 | $ 5.87 |
| Total Medical Services | N/A | N/A | $ 428.80 | 0.00% | 0.62% | 0.14% | N/A | N/A | $ 432.06 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | East |
| Rating Group: | All COAs; Delivery (F) |
| State Fiscal Year: | 2025 |
| Base Deliveries: | 7,784 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPD | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPD |
| Inpatient Hospital - PH | 2,611 | $ 2,675.10 | $ 6,985.89 | 0.00% | 1.28% | 0.00% | 2,645 | $ 2,675.24 | $ 7,075.37 |
| Inpatient Hospital - BH | - 0 | $ - 0 | $ 1.05 | 0.00% | 0.72% | 0.00% | - 0 | $ 2,718.01 | $ 1.06 |
| Emergency Room | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Outpatient Hospital - PH | 143 | $ 447.36 | $ 64.14 | 0.00% | 0.18% | 0.00% | 144 | $ 447.31 | $ 64.25 |
| Outpatient Hospital - BH | 1 | $ 332.65 | $ 0.21 | 0.00% | 0.16% | 0.00% | 1 | $ 332.47 | $ 0.21 |
| Physician Services | 3,185 | $ 376.27 | $ 1,198.58 | 0.00% | 0.15% | 0.00% | 3,190 | $ 376.26 | $ 1,200.33 |
| Behavioral Health | 18 | $ 147.50 | $ 2.67 | 0.00% | 0.10% | 0.00% | 18 | $ 147.46 | $ 2.68 |
| Dental | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Emergency Transportation | 78 | $ 349.14 | $ 27.12 | 0.00% | 0.30% | 0.00% | 78 | $ 349.27 | $ 27.20 |
| Non-Emergency Medical Transportation | 41 | $ 56.38 | $ 2.30 | 0.00% | 0.14% | 0.00% | 41 | $ 56.38 | $ 2.30 |
| Durable Medical Equipment | 29 | $ 71.26 | $ 2.05 | 0.00% | 0.16% | 0.00% | 29 | $ 71.26 | $ 2.06 |
| Optometric Services | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Laboratory and X-Ray | 854 | $ 51.07 | $ 43.61 | 0.00% | 0.29% | 0.00% | 856 | $ 51.07 | $ 43.73 |
| Other Services | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 49 | $ 143.73 | $ 7.00 | 0.00% | 0.13% | 0.00% | 49 | $ 143.71 | $ 7.01 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Total Medical Services | N/A | N/A | $ 8,334.62 | 0.00% | 1.10% | 0.00% | N/A | N/A | $ 8,426.20 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| &"Arial"&10&"Arial,Bold"State of Missouri | &"Arial"&12&12Appendix A |
| Encounter Base Data Development Exhibit | Final |
&"Arial"&G &"Arial"&10 &"Arial"&8
GP Base Data - West
| Region: | West |
| Rating Group: | COA 1; < 1 year (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 87,492 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 3,346 | $ 3,437.62 | $ 958.54 | 0.00% | 1.18% | 0.02% | 3,386 | $ 3,437.66 | $ 970.01 |
| Inpatient Hospital - BH | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Emergency Room | 903 | $ 1,154.50 | $ 86.86 | 0.00% | 0.16% | 0.01% | 905 | $ 1,154.15 | $ 87.00 |
| Outpatient Hospital - PH | 2,936 | $ 424.61 | $ 103.90 | 0.00% | 0.19% | 0.01% | 2,942 | $ 424.61 | $ 104.10 |
| Outpatient Hospital - BH | 6 | $ 579.62 | $ 0.31 | 0.00% | 0.20% | 0.00% | 6 | $ 579.90 | $ 0.31 |
| Physician Services | 14,698 | $ 90.25 | $ 110.54 | 0.00% | 0.16% | 2.66% | 15,106 | $ 90.29 | $ 113.66 |
| Behavioral Health | 7 | $ 94.15 | $ 0.05 | 0.00% | 0.28% | 0.01% | 7 | $ 94.15 | $ 0.05 |
| Dental | 77 | $ 58.78 | $ 0.38 | 0.00% | 0.12% | 0.15% | 78 | $ 58.79 | $ 0.38 |
| Emergency Transportation | 114 | $ 330.13 | $ 3.15 | 0.00% | 0.31% | 0.02% | 115 | $ 330.17 | $ 3.16 |
| Non-Emergency Medical Transportation | 139 | $ 64.90 | $ 0.75 | -0.73% | 0.33% | 0.00% | 140 | $ 64.45 | $ 0.75 |
| Durable Medical Equipment | 346 | $ 260.74 | $ 7.51 | 0.00% | 0.27% | 0.01% | 347 | $ 260.76 | $ 7.53 |
| Optometric Services | 1 | $ 51.40 | $ - 0 | 0.00% | 0.23% | 0.00% | 1 | $ 51.40 | $ - 0 |
| Laboratory and X-Ray | 1,810 | $ 23.41 | $ 3.53 | 0.00% | 0.30% | 0.01% | 1,815 | $ 23.41 | $ 3.54 |
| Other Services | 79 | $ 362.17 | $ 2.37 | 0.00% | 0.18% | 0.05% | 79 | $ 361.67 | $ 2.38 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,693 | $ 132.26 | $ 18.66 | 0.00% | 0.15% | 0.00% | 1,696 | $ 132.26 | $ 18.69 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.01% | 0.00% | - 0 | $ 133.09 | $ - 0 |
| Total Medical Services | N/A | N/A | $ 1,296.55 | 0.00% | 0.91% | 0.24% | N/A | N/A | $ 1,311.56 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | West |
| Rating Group: | COA 1; Children < 21 (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 1,216,810 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 72 | $ 5,392.00 | $ 32.41 | 0.00% | 1.38% | 0.00% | 73 | $ 5,391.86 | $ 32.86 |
| Inpatient Hospital - BH | 77 | $ 1,786.56 | $ 11.45 | 0.00% | 1.34% | 0.04% | 78 | $ 1,786.59 | $ 11.61 |
| Emergency Room | 425 | $ 1,134.64 | $ 40.18 | 0.00% | 0.15% | 0.01% | 426 | $ 1,134.34 | $ 40.24 |
| Outpatient Hospital - PH | 945 | $ 704.47 | $ 55.49 | 0.00% | 0.17% | 0.01% | 947 | $ 704.39 | $ 55.59 |
| Outpatient Hospital - BH | 116 | $ 326.21 | $ 3.15 | 0.00% | 0.18% | 0.02% | 116 | $ 326.22 | $ 3.16 |
| Physician Services | 2,832 | $ 81.47 | $ 19.23 | 0.00% | 0.15% | 4.19% | 2,954 | $ 81.51 | $ 20.07 |
| Behavioral Health | 672 | $ 124.42 | $ 6.97 | 0.00% | 0.15% | 0.17% | 674 | $ 124.39 | $ 6.99 |
| Dental | 3,970 | $ 88.07 | $ 29.14 | 0.00% | 0.13% | 0.00% | 3,975 | $ 88.08 | $ 29.18 |
| Emergency Transportation | 61 | $ 257.45 | $ 1.31 | 0.00% | 0.27% | 0.03% | 61 | $ 257.46 | $ 1.32 |
| Non-Emergency Medical Transportation | 117 | $ 69.87 | $ 0.68 | -0.78% | 0.23% | 0.00% | 117 | $ 69.34 | $ 0.68 |
| Durable Medical Equipment | 239 | $ 183.22 | $ 3.65 | -0.03% | 0.29% | 0.03% | 240 | $ 183.17 | $ 3.66 |
| Optometric Services | 404 | $ 34.04 | $ 1.15 | 0.00% | 0.14% | 0.00% | 405 | $ 34.03 | $ 1.15 |
| Laboratory and X-Ray | 986 | $ 21.24 | $ 1.75 | 0.00% | 0.23% | 0.03% | 988 | $ 21.24 | $ 1.75 |
| Other Services | 171 | $ 586.75 | $ 8.35 | 0.00% | 0.21% | 0.05% | 171 | $ 586.60 | $ 8.37 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,476 | $ 107.26 | $ 13.19 | 0.00% | 0.14% | 0.01% | 1,478 | $ 107.25 | $ 13.21 |
| CCBHO | 432 | $ 136.65 | $ 4.91 | 0.00% | 0.08% | 0.00% | 432 | $ 136.65 | $ 4.92 |
| Total Medical Services | N/A | N/A | $ 233.01 | 0.00% | 0.39% | 0.36% | N/A | N/A | $ 234.75 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | West |
| Rating Group: | COA 1; Adults 21+ (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 193,298 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 256 | $ 2,603.51 | $ 55.44 | 0.00% | 1.31% | 0.04% | 259 | $ 2,603.54 | $ 56.19 |
| Inpatient Hospital - BH | 99 | $ 1,918.71 | $ 15.85 | 0.00% | 1.26% | 0.03% | 100 | $ 1,918.72 | $ 16.05 |
| Emergency Room | 1,175 | $ 874.93 | $ 85.65 | 0.00% | 0.18% | 0.04% | 1,177 | $ 874.95 | $ 85.84 |
| Outpatient Hospital - PH | 1,909 | $ 608.51 | $ 96.79 | 0.00% | 0.17% | 0.04% | 1,913 | $ 608.52 | $ 96.99 |
| Outpatient Hospital - BH | 94 | $ 288.78 | $ 2.27 | 0.00% | 0.15% | 0.06% | 94 | $ 288.77 | $ 2.27 |
| Physician Services | 4,139 | $ 108.97 | $ 37.58 | 0.00% | 0.14% | 4.56% | 4,335 | $ 108.95 | $ 39.35 |
| Behavioral Health | 847 | $ 96.45 | $ 6.81 | 0.00% | 0.13% | 0.19% | 850 | $ 96.46 | $ 6.83 |
| Dental | 1,606 | $ 120.44 | $ 16.11 | 0.00% | 0.14% | 0.00% | 1,608 | $ 120.45 | $ 16.14 |
| Emergency Transportation | 259 | $ 244.60 | $ 5.28 | 0.00% | 0.27% | 0.03% | 260 | $ 244.60 | $ 5.29 |
| Non-Emergency Medical Transportation | 382 | $ 67.83 | $ 2.16 | -0.25% | 0.30% | 0.00% | 383 | $ 67.68 | $ 2.16 |
| Durable Medical Equipment | 295 | $ 95.36 | $ 2.35 | -1.26% | 0.27% | 0.03% | 296 | $ 94.18 | $ 2.32 |
| Optometric Services | 279 | $ 33.91 | $ 0.79 | 0.00% | 0.14% | 0.00% | 279 | $ 33.90 | $ 0.79 |
| Laboratory and X-Ray | 4,351 | $ 29.87 | $ 10.83 | 0.00% | 0.24% | 0.05% | 4,364 | $ 29.87 | $ 10.86 |
| Other Services | 43 | $ 337.27 | $ 1.20 | 0.00% | 0.20% | 0.12% | 43 | $ 337.02 | $ 1.20 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,454 | $ 131.03 | $ 15.88 | 0.00% | 0.15% | 0.07% | 1,458 | $ 131.02 | $ 15.91 |
| CCBHO | 585 | $ 153.04 | $ 7.46 | 0.00% | 0.10% | 0.00% | 585 | $ 153.04 | $ 7.47 |
| Total Medical Services | N/A | N/A | $ 362.44 | -0.01% | 0.39% | 0.51% | N/A | N/A | $ 365.67 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | West |
| Rating Group: | COA 2; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 91,641 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 155 | $ 2,786.24 | $ 36.03 | 0.00% | 1.39% | 0.39% | 158 | $ 2,785.77 | $ 36.67 |
| Inpatient Hospital - BH | 36 | $ 2,223.39 | $ 6.63 | 0.00% | 1.28% | 0.03% | 36 | $ 2,222.56 | $ 6.72 |
| Emergency Room | 1,211 | $ 732.44 | $ 73.90 | 0.00% | 0.20% | 0.03% | 1,214 | $ 732.46 | $ 74.07 |
| Outpatient Hospital - PH | 5,381 | $ 408.32 | $ 183.11 | 0.00% | 0.20% | 0.04% | 5,394 | $ 408.31 | $ 183.54 |
| Outpatient Hospital - BH | 62 | $ 273.24 | $ 1.41 | 0.00% | 0.18% | 0.05% | 62 | $ 273.24 | $ 1.41 |
| Physician Services | 6,800 | $ 103.07 | $ 58.41 | 0.00% | 0.17% | 5.65% | 7,197 | $ 103.06 | $ 61.81 |
| Behavioral Health | 509 | $ 121.15 | $ 5.14 | 0.00% | 0.14% | 0.26% | 511 | $ 121.17 | $ 5.16 |
| Dental | 1,869 | $ 148.88 | $ 23.19 | 0.00% | 0.14% | 0.00% | 1,872 | $ 148.87 | $ 23.22 |
| Emergency Transportation | 222 | $ 241.11 | $ 4.46 | 0.00% | 0.31% | 0.04% | 223 | $ 241.10 | $ 4.48 |
| Non-Emergency Medical Transportation | 557 | $ 57.71 | $ 2.68 | -0.21% | 0.29% | 0.00% | 559 | $ 57.60 | $ 2.68 |
| Durable Medical Equipment | 314 | $ 100.02 | $ 2.61 | -26.86% | 0.31% | 0.06% | 314 | $ 73.22 | $ 1.92 |
| Optometric Services | 263 | $ 33.20 | $ 0.73 | 0.00% | 0.16% | 0.00% | 264 | $ 33.19 | $ 0.73 |
| Laboratory and X-Ray | 8,198 | $ 44.75 | $ 30.57 | 0.00% | 0.29% | 0.18% | 8,237 | $ 44.74 | $ 30.71 |
| Other Services | 3 | $ 122.43 | $ 0.03 | 0.00% | 0.09% | 0.00% | 3 | $ 122.43 | $ 0.03 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 2,783 | $ 121.86 | $ 28.26 | 0.00% | 0.17% | 0.15% | 2,792 | $ 121.86 | $ 28.35 |
| CCBHO | 294 | $ 149.33 | $ 3.66 | 0.00% | 0.12% | 0.00% | 295 | $ 149.33 | $ 3.67 |
| Total Medical Services | N/A | N/A | $ 460.81 | -0.15% | 0.31% | 0.79% | N/A | N/A | $ 465.17 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | West |
| Rating Group: | COA 5; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 166,109 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 111 | $ 3,957.75 | $ 36.51 | 0.00% | 1.29% | 0.01% | 112 | $ 3,958.40 | $ 36.98 |
| Inpatient Hospital - BH | 48 | $ 1,960.37 | $ 7.81 | 0.00% | 1.35% | 0.04% | 48 | $ 1,960.27 | $ 7.92 |
| Emergency Room | 295 | $ 1,231.53 | $ 30.30 | 0.00% | 0.15% | 0.01% | 296 | $ 1,231.09 | $ 30.35 |
| Outpatient Hospital - PH | 993 | $ 735.89 | $ 60.89 | 0.00% | 0.17% | 0.01% | 995 | $ 735.82 | $ 61.00 |
| Outpatient Hospital - BH | 125 | $ 315.63 | $ 3.28 | 0.00% | 0.18% | 0.02% | 125 | $ 315.62 | $ 3.29 |
| Physician Services | 3,218 | $ 82.64 | $ 22.16 | 0.00% | 0.14% | 3.64% | 3,339 | $ 82.68 | $ 23.00 |
| Behavioral Health | 780 | $ 101.14 | $ 6.58 | 0.00% | 0.15% | 0.18% | 783 | $ 101.13 | $ 6.60 |
| Dental | 3,822 | $ 82.54 | $ 26.29 | 0.00% | 0.13% | 0.00% | 3,826 | $ 82.54 | $ 26.32 |
| Emergency Transportation | 37 | $ 286.46 | $ 0.89 | 0.00% | 0.30% | 0.04% | 37 | $ 286.51 | $ 0.89 |
| Non-Emergency Medical Transportation | 28 | $ 100.92 | $ 0.23 | -92.10% | 3.59% | 0.02% | 28 | $ 8.25 | $ 0.02 |
| Durable Medical Equipment | 204 | $ 176.76 | $ 3.01 | -0.02% | 0.27% | 0.04% | 205 | $ 176.67 | $ 3.01 |
| Optometric Services | 347 | $ 33.22 | $ 0.96 | 0.00% | 0.11% | 0.00% | 348 | $ 33.21 | $ 0.96 |
| Laboratory and X-Ray | 1,013 | $ 22.55 | $ 1.90 | 0.00% | 0.24% | 0.03% | 1,016 | $ 22.55 | $ 1.91 |
| Other Services | 140 | $ 518.84 | $ 6.07 | 0.00% | 0.35% | 0.05% | 141 | $ 518.73 | $ 6.10 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 1,261 | $ 114.76 | $ 12.06 | 0.00% | 0.13% | 0.02% | 1,263 | $ 114.76 | $ 12.08 |
| CCBHO | 424 | $ 142.31 | $ 5.02 | 0.00% | 0.07% | 0.00% | 424 | $ 142.31 | $ 5.03 |
| Total Medical Services | N/A | N/A | $ 223.96 | -0.10% | 0.39% | 0.38% | N/A | N/A | $ 225.46 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | West |
| Rating Group: | COA 6; All Age Groups |
| State Fiscal Year: | 2025 |
| Base Member Months: | 835,389 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 494 | $ 2,630.81 | $ 108.23 | 0.00% | 1.29% | 0.03% | 500 | $ 2,630.75 | $ 109.66 |
| Inpatient Hospital - BH | 242 | $ 2,057.56 | $ 41.46 | 0.00% | 1.30% | 0.03% | 245 | $ 2,057.56 | $ 42.02 |
| Emergency Room | 1,107 | $ 930.24 | $ 85.80 | 0.00% | 0.20% | 0.04% | 1,109 | $ 930.28 | $ 86.00 |
| Outpatient Hospital - PH | 1,983 | $ 652.21 | $ 107.76 | 0.00% | 0.18% | 0.04% | 1,987 | $ 652.22 | $ 108.00 |
| Outpatient Hospital - BH | 127 | $ 343.11 | $ 3.62 | 0.00% | 0.15% | 0.08% | 127 | $ 343.09 | $ 3.63 |
| Physician Services | 4,748 | $ 110.79 | $ 43.84 | 0.00% | 0.16% | 0.94% | 4,800 | $ 110.79 | $ 44.32 |
| Behavioral Health | 1,002 | $ 94.30 | $ 7.88 | 0.00% | 0.14% | 0.20% | 1,006 | $ 94.31 | $ 7.90 |
| Dental | 1,355 | $ 118.86 | $ 13.42 | 0.00% | 0.15% | 0.00% | 1,357 | $ 118.86 | $ 13.44 |
| Emergency Transportation | 398 | $ 237.97 | $ 7.89 | 0.00% | 0.28% | 0.04% | 399 | $ 237.97 | $ 7.92 |
| Non-Emergency Medical Transportation | 494 | $ 65.11 | $ 2.68 | -0.20% | 0.29% | 0.00% | 495 | $ 64.99 | $ 2.68 |
| Durable Medical Equipment | 404 | $ 105.68 | $ 3.56 | -0.34% | 0.23% | 0.04% | 405 | $ 105.31 | $ 3.56 |
| Optometric Services | 272 | $ 35.57 | $ 0.81 | 0.00% | 0.16% | 0.00% | 273 | $ 35.56 | $ 0.81 |
| Laboratory and X-Ray | 4,007 | $ 28.96 | $ 9.67 | 0.00% | 0.26% | 0.03% | 4,019 | $ 28.96 | $ 9.70 |
| Other Services | 30 | $ 190.63 | $ 0.48 | 0.00% | 0.35% | 0.30% | 30 | $ 190.76 | $ 0.48 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.76% | 0.00% | - 0 | $ 118.10 | $ - 0 |
| FQHC/RHC | 1,340 | $ 127.56 | $ 14.25 | 0.00% | 0.17% | 0.03% | 1,343 | $ 127.56 | $ 14.28 |
| CCBHO | 684 | $ 147.57 | $ 8.41 | 0.00% | 0.10% | 0.00% | 685 | $ 147.57 | $ 8.42 |
| Total Medical Services | N/A | N/A | $ 459.77 | 0.00% | 0.55% | 0.12% | N/A | N/A | $ 462.83 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| Region: | West |
| Rating Group: | All COAs; Delivery (F) |
| State Fiscal Year: | 2025 |
| Base Deliveries: | 6,117 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPD | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPD |
| Inpatient Hospital - PH | 2,538 | $ 2,677.96 | $ 6,796.75 | 0.00% | 1.25% | 0.00% | 2,570 | $ 2,678.04 | $ 6,881.93 |
| Inpatient Hospital - BH | - 0 | $ - 0 | $ 0.60 | 0.00% | 1.93% | 0.00% | - 0 | $ 1,827.08 | $ 0.61 |
| Emergency Room | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Outpatient Hospital - PH | 365 | $ 524.15 | $ 191.51 | 0.00% | 0.16% | 0.00% | 366 | $ 524.14 | $ 191.82 |
| Outpatient Hospital - BH | - 0 | $ - 0 | $ 0.19 | 0.00% | 0.00% | 0.00% | - 0 | $ 569.33 | $ 0.19 |
| Physician Services | 2,837 | $ 328.55 | $ 932.08 | 0.00% | 0.14% | 0.00% | 2,841 | $ 328.55 | $ 933.43 |
| Behavioral Health | 16 | $ 130.19 | $ 2.02 | 0.00% | 0.11% | 0.00% | 16 | $ 130.16 | $ 2.03 |
| Dental | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Emergency Transportation | 57 | $ 333.13 | $ 18.91 | 0.00% | 0.23% | 0.00% | 57 | $ 333.08 | $ 18.96 |
| Non-Emergency Medical Transportation | 23 | $ 58.90 | $ 1.37 | 0.00% | 0.04% | 0.00% | 23 | $ 58.89 | $ 1.37 |
| Durable Medical Equipment | 26 | $ 76.48 | $ 1.96 | 0.00% | 0.14% | 0.00% | 26 | $ 76.47 | $ 1.97 |
| Optometric Services | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Laboratory and X-Ray | 762 | $ 44.86 | $ 34.17 | 0.00% | 0.24% | 0.00% | 764 | $ 44.85 | $ 34.25 |
| Other Services | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 60 | $ 178.96 | $ 10.79 | 0.00% | 0.07% | 0.00% | 60 | $ 178.90 | $ 10.79 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Total Medical Services | N/A | N/A | $ 7,990.35 | 0.00% | 1.09% | 0.00% | N/A | N/A | $ 8,077.33 |
| Notes: |
| 1. In some cases totals may not equal the sum of their respective column components due to rounding. |
| 2. Encounter base data includes adjustments for shadow pricing of subcapitation arrangements. |
| 3. Encounter base data reflects SFY 2025 health plan encounter data with payments through December 12, 2025 that has been submitted and accepted in the State's MMIS system. |
| 4. Supporting documentation can be found in the SFY 2028 MO HealthNet Managed Care Actuarial Memo dated April 10, 2026. |
| &"Arial"&10&"Arial,Bold"State of Missouri | &"Arial"&12&12Appendix A |
| Encounter Base Data Development Exhibit | Final |
&"Arial"&G &"Arial"&10 &"Arial"&8
GP Base Data - Southwest
| Region: | Southwest |
| Rating Group: | COA 1; < 1 year (M&F) |
| State Fiscal Year: | 2025 |
| Base Member Months: | 76,394 |
| Encounter Base Data | | | Adjustments | | | Final Base Data | | |
| Category of Service | Utilization per 1000 | Unit Cost | PMPM | Non-State Plan Service Removal | IBNR | Additional Provider Payments | Utilization per 1000 | Unit Cost | PMPM |
| Inpatient Hospital - PH | 3,707 | $ 2,949.60 | $ 911.19 | 0.00% | 1.19% | 0.04% | 3,752 | $ 2,949.80 | $ 922.41 |
| Inpatient Hospital - BH | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| Emergency Room | 795 | $ 762.32 | $ 50.49 | 0.00% | 0.17% | 0.05% | 796 | $ 762.32 | $ 50.60 |
| Outpatient Hospital - PH | 1,520 | $ 374.17 | $ 47.40 | 0.00% | 0.18% | 0.05% | 1,523 | $ 374.17 | $ 47.50 |
| Outpatient Hospital - BH | 12 | $ 243.91 | $ 0.24 | 0.00% | 0.15% | 0.06% | 12 | $ 243.95 | $ 0.24 |
| Physician Services | 16,095 | $ 108.95 | $ 146.13 | 0.00% | 0.14% | 3.79% | 16,723 | $ 108.99 | $ 151.88 |
| Behavioral Health | 14 | $ 341.26 | $ 0.40 | 0.00% | 0.07% | 0.04% | 14 | $ 340.72 | $ 0.40 |
| Dental | 135 | $ 69.98 | $ 0.79 | 0.00% | 0.14% | 0.07% | 135 | $ 69.98 | $ 0.79 |
| Emergency Transportation | 124 | $ 931.37 | $ 9.63 | 0.00% | 0.28% | 0.05% | 124 | $ 931.46 | $ 9.66 |
| Non-Emergency Medical Transportation | 100 | $ 302.58 | $ 2.53 | -0.23% | 0.30% | 0.00% | 100 | $ 302.09 | $ 2.53 |
| Durable Medical Equipment | 416 | $ 153.97 | $ 5.34 | 0.00% | 0.33% | 0.03% | 418 | $ 154.01 | $ 5.36 |
| Optometric Services | 4 | $ 24.57 | $ 0.01 | 0.00% | 0.25% | 0.00% | 4 | $ 24.59 | $ 0.01 |
| Laboratory and X-Ray | 2,258 | $ 25.63 | $ 4.82 | 0.00% | 0.21% | 0.04% | 2,264 | $ 25.62 | $ 4.83 |
| Other Services | 56 | $ 614.40 | $ 2.87 | 0.00% | 0.84% | 0.09% | 56 | $ 614.64 | $ 2.89 |
| CMHC | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
| FQHC/RHC | 3,197 | $ 145.60 | $ 38.79 | 0.00% | 0.15% | 0.00% | 3,202 | $ 145.60 | $ 38.85 |
| CCBHO | - 0 | $ - 0 | $ - 0 | 0.00% | 0.00% | 0.00% | - 0 | $ - 0 | $ - 0 |
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