November 27, 2017

The Honorable Steve Yarbrough Arizona State Senate
1700 W. Washington
Phoenix, AZ 85007

The Honorable J.D. Mesnard Speaker of the House
Arizona House of Representatives 1700 W. Washington
Phoenix, AZ 85007

Douglas A. Ducey, Governor Thomas J. Betlach, Director

SUBJECT:  FY 2018 Appropriation Status Report for the Period Ended October 31, 2017

Dear President Yarbrough and Speaker Mesnard:

Pursuant to A.R.S. §’s 36-2920 and 36-2994, enclosed is the Arizona Health Care Cost Containment System’s (AHCCCS) Appropriation Status Report (ASR) for the period ended October 31, 2017.

Status Summary – As part of the FY 2019 budget revision submitted to the Governor’s Office  of Strategic Planning and Budgeting on October 31st, a FY 2018 rebase was  prepared.  AHCCCS is currently forecasting a FY 2018 Total Fund shortfall of $152.7 million. This shortfall is comprised of $134.0 million Federal Expenditure Authority and $18.7 million Hospital Assessment Fund Authority.

There are several issues this fiscal year that have the potential to affect the projected shortfall. They include:
Continued volatility in caseload growth and prior period expenditures.
CHIP Funding Reauthorization.
Final Medicare Premium rate increases.
Potential Agency audit liabilities, which are detailed in the ASR.

AHCCCS also intends to utilize surplus FY 2017 General Fund and Expenditure Authority for administrative adjustments of expenditures with dates of service prior to July 1, 2017.

Given these issues and options, for purposes of this report, projected annual expenditures equal the FY 2018 appropriations.

Enrollment Update – October 2017 enrollment is 1,921,145 members, a 778 member increase over the prior month. Enrollment for November 2017 decreased to 1,918,190 members, a 2,955 member change.

801 East Jefferson, Phoenix, AZ 85034 • PO Box 25520, Phoenix, AZ 85002 • 602-417-4000 • www.azahcccs.gov

The Honorable Steve Yarbrough The Honorable J.D. Mesnard November 27, 2017
Page 2

Major   November  2017  changes  by  eligibility  category  include:  1931  for  Families        and
Children/SOBRA – decrease of 3,585; Supplemental Security Income – increase of 416; Prop 204 Restoration - decrease of 788; Adult Expansion – decrease of 460; Medicare Cost Sharing – increase of 688; KidsCare – increase of 650; and Federal Emergency Services - decrease of 59.

Tobacco Funds Revenue Update - Tobacco tax collections through October 2017 are $477,000 less than the AHCCCS monthly projected flows. AHCCCS will continue to monitor the tobacco funds revenue collections to determine any impact on the FY 2018 appropriations.

If you have any questions about this report, please do not hesitate to call me at (602) 417-4111 or Jeffery Tegen at (602) 417-4705.

Sincerel ,

Thomas J. Betlach Director

Enclosure

cc:	The Honorable Douglas A. Ducey, Governor
The Honorable, Debbie Lesko, Chairman, Senate Appropriations Committee
The Honorable David Livingston, Acting Chairman, House Appropriations Committee The Honorable Nancy Barto, Chairman, Senate Health and Human Services Committee The Honorable Heather Carter, Chairman, House Health Committee
Matthew Gress, Director, Governor’s Office of Strategic Planning and Budgeting Richard Stavneak, Director, Joint Legislative Budget Committee

Appropriation Status Report (ASR)
Fiscal Year 2018
Through October 31, 2017

Prepared by: Division of Business and Finance

Appropriation Status Report
Table of Contents
APPROPRIATED SOURCES AND USES OF FUNDS	Page
Summary of Appropriated Expenditures for SFY 2018…	2
Appropriated Expenditures by Funding Source…	3
Appropriated Revenue Received Detail Schedule…	5
FOOTNOTES	7
CASELOAD AND EXPENDITURES BY RATE CODE	10

Appropriation Status Report
Appropriated Sources and Uses of Funds

ARIZONA  HEALTH  CARE  COST  CONTAINMENT SYSTEM
FY 2018 APPROPRIATION STATUS REPORT
For the Period Ending October 31,  2017
SUMMARY OF APPROPRIATED EXPENDITURES

	

ANNUAL APPROPRIATION		(A)      EXPENDITURE PLAN
YTD		(B)

EXPENDITURES YTD		(A) - (B)

VARIANCE YTD		
PROJECTED ANNUAL EXPENDITURES		

ANNUALIZED VARIANCE		

APPROPRIATIONS:													
ADMINISTRATION													
AHCCCS Operating Lump Sum	$	94,260,300		$	25,980,240		$	32,961,017		$	(6,980,777)		$	94,260,300		$	-		
AHCCCS Prop 204 Administration	13,936,000		3,789,789		4,294,619		(504,830)		13,936,000		-		
DES Eligibility	91,874,500		30,362,500		22,746,184		7,616,316		91,874,500		-		
DES Prop 204 Eligibility	44,358,700		15,241,700		9,356,960		5,884,740		44,358,700		-		
Prop 206 Provider Assessment Study	200,000		31,944		-		31,944		200,000		-		
TOTAL  ADMINISTRATION	 	244,629,500 		 	75,406,172 		 	69,358,779 		 	6,047,393 		 	244,629,500 		 	-			

Traditional Medicaid Services	3,896,328,000	1,291,389,300	1,257,128,159	34,261,141	3,896,328,000	-	
Proposition 204 Services	2,773,331,800	896,361,000	899,031,826	(2,670,826)	2,773,331,800	-	
ACA Adult Expansion	475,591,600	166,172,500	160,945,052	5,227,448	475,591,600	-	
Children's Rehabilitative Services	269,646,300	86,570,100	101,103,701	(14,533,601)	269,646,300	-	
KidsCare Services	111,961,100	30,575,100	17,577,308	12,997,792	111,961,100	-	
ALTCS Services	1,544,082,800	493,672,800	499,014,691	(5,341,891)	1,544,082,800	-	
Disproportionate Share Payments	5,087,100	-	-	-	5,087,100	-	
Rural Hospitals	22,650,000	-	-	-	22,650,000	-	
Voluntary Political Subdivision Programs	340,729,800	10,258,100	10,258,054	46	340,729,800	-	
Behavioral Health Traditional Medicaid Services	1,156,192,500	366,459,900	385,133,161	(18,673,261)	1,156,192,500	-	
Behavioral Health Proposition 204 Services	788,262,700	245,450,900	270,031,666	(24,580,766)	788,262,700	-	
Behavioral Health ACA Adult Expansion	86,141,400	25,852,900	28,865,678	(3,012,778)	86,141,400	-	
Behavioral Health CMDP	217,719,100	76,550,400	49,138,338	27,412,062	217,719,100	-	
Non Medicaid Seriously Mentally Ill Services	78,846,900	26,282,400	25,896,821	385,579	78,846,900	-	
Supported Housing	5,324,800	1,774,800	1,747,759	27,041	5,324,800	-	
Crisis Services	16,391,300	5,463,600	5,435,433	28,167	16,391,300	-	

TOTAL PROGRAMMATIC	 	11,788,287,200	 	3,722,833,800	 	3,711,307,649	 	11,526,151	 	11,788,287,200	 	-	

TOTAL EXPENDITURES

$	12,032,916,700

$	3,798,239,972

$	3,780,666,428

$	17,573,545

$   12,032,916,700	$	-

2

ARIZONA  HEALTH  CARE  COST  CONTAINMENT SYSTEM
FY 2018 APPROPRIATION STATUS REPORT
For the Period Ending October 31, 2017 APPROPRIATED EXPENDITURES BY FUNDING SOURCE

ANNUAL APPROPRIATION	(A)      EXPENDITURE PLAN
YTD	(B)

EXPENDITURES YTD	(A) - (B)

VARIANCE YTD	
PROJECTED ANNUAL EXPENDITURES	

ANNUALIZED VARIANCE	

STATE - GENERAL FUND		
Administrative Expenditures	$	55,962,100	$	17,108,567	$	18,587,156	(1,478,589)	$	55,962,100	$	-	
Proposition 204 - Administrative Expenditures	21,765,400	7,107,487	3,656,959	3,450,529	21,765,400	-	

Programmatic Expenditures							
Traditional Medicaid Services	830,106,600	275,794,800	263,077,132	12,717,668	830,106,600	-	
Proposition 204 Services	-	-	(1,159,535)	1,159,535	-	-
Children's Rehabilitative Services	81,426,000	26,416,400	26,515,445	(99,045)	81,426,000	- KidsCare Services		-		-		(84,206)		84,206		-	-
ALTCS Services	185,064,700	61,161,600	61,688,233	(526,633)	185,064,700	-
DSH and Rural Hospitals	7,086,300	-	-	-	7,086,300	-
Behavioral Health Traditional Medicaid Services	316,050,500	101,306,400	106,892,025	(5,585,625)	316,050,500	-	
Behavioral Health Proposition 204 Services	109,562,000	35,483,200	39,648,646	(4,165,446)	109,562,000	-	
Behavioral Health ACA Adult Expansion	4,269,200	1,159,900	1,442,666	(282,766)	4,269,200	-	
Behavioral Health CMDP	65,719,400	23,354,900	15,043,768	8,311,132	65,719,400	-	
Non Medicaid Seriously Mentally Ill Services	78,846,900	26,282,400	25,896,821	385,579	78,846,900	-	
Supported Housing	5,324,800	1,774,800	1,747,759	27,041	5,324,800	-	
Crisis Services	 	14,141,100 	 	4,713,600 	 	4,685,367 	 	28,233 	 	14,141,100 	 	- 	
TOTAL GF EXPENDITURES	1,775,325,000	581,664,055	567,638,236	14,025,818	1,775,325,000	-	

FEDERAL		
Administrative Expenditures	129,511,800	39,032,931	36,995,842	2,037,089	129,511,800	-	
Proposition 204 - Administrative Expenditures	32,874,000	10,668,101	9,994,620	673,481	32,874,000	-	

Programmatic Expenditures	
Traditional Medicaid Services	2,412,443,400	798,710,200	753,047,960	45,662,240	2,412,443,400	-	
Proposition 204 Services	2,397,123,600	779,957,500	772,412,337	7,545,163	2,397,123,600	-	
ACA Adult Expansion	450,284,200	158,126,500	153,450,419	4,676,081	450,284,200	-	
Children's Rehabilitative Services	188,220,300	60,153,700	74,588,256	(14,434,556)	188,220,300	-	
KidsCare Services	99,809,800	27,225,900	15,933,608	11,292,292	99,809,800	-	
ALTCS Services and Nursing Facility Assessment	956,062,900	311,793,300	315,644,297	(3,850,997)	956,062,900	-	
DSH and Rural Hospitals
Behavioral Health Traditional Medicaid Services	20,650,800
804,576,200	- 253,753,200	- 266,072,936	- (12,319,736)	20,650,800
804,576,200	-
-	
Behavioral Health Proposition 204 Services	655,527,700	202,462,800	223,110,014	(20,647,214)	655,527,700	-	
Behavioral Health ACA Adult Expansion	81,390,900	24,572,600	27,423,012	(2,850,412)	81,390,900	-	
Behavioral Health CMDP	151,999,700	53,195,500	34,094,569	19,100,931	151,999,700	-	
Voluntary Political Subdivision Programs - See Note 5	 	237,582,300 	 	7,058,100 	 	7,058,054 	 	46 	 	237,582,300 	 	- 	
TOTAL FEDERAL EXPENDITURES	8,618,057,600	2,726,710,333	2,689,825,926	36,884,407	8,618,057,600	-	

COUNTY		
Administrative Expenditures Proposition 204 - BNCF	3,655,300	1,255,900	-	1,255,900	3,655,300	-	
Programmatic Expenditures					
Traditional Medicaid Services Acute Care	49,687,700	16,578,800	16,578,800	-	49,687,700	-	
ALTCS Services	 	249,980,000 	 	87,470,500 	 	87,794,400	 	(323,900)	 	249,980,000 	 	- 	
TOTAL COUNTY EXPENDITURES	303,323,000	105,305,200	104,373,200	932,000	303,323,000	-	

ARIZONA  HEALTH  CARE  COST  CONTAINMENT SYSTEM
FY 2018 APPROPRIATION STATUS REPORT
For the Period Ending October 31, 2017 APPROPRIATED EXPENDITURES BY FUNDING SOURCE

	(A)	(B)	(A) - (B)			
	EXPENDITURE			PROJECTED		
ANNUAL	PLAN	EXPENDITURES	VARIANCE	ANNUAL	ANNUALIZED	
APPROPRIATION	YTD	YTD	YTD	EXPENDITURES	VARIANCE	

	TOBACCO FUNDS		

Programmatic Expenditures			
Traditional Medicaid Services - Medically Needy		37,432,400	12,547,400	12,806,823	(259,423)	37,432,400	-	
Behavioral Health Traditional Medicaid Services - Medically Needy		35,565,800	11,400,300	12,168,200	(767,900)	35,565,800	-	
Proposition 204 Services - Emergency Health Services		19,244,300	6,639,600	6,113,034	526,566	19,244,300	-	
Proposition 204 Services - Proposition 204 Protection		17,240,000	5,948,200	5,563,749	384,451	17,240,000	-	
Behavioral Health Proposition 204 Services - Proposition 204 Protection		23,173,000	7,504,900	7,273,005	231,895	23,173,000	-	
Proposition 204 Services - ATLSF	 	79,000,000 	 	- 	 	- 	 	- 	 	79,000,000 	 	- 	
TOTAL TOBACCO EXPENDITURES	211,655,500	44,040,400	43,924,812	115,588	211,655,500	-	

Administrative Expenditures Prescription Drug Rebate Program
Programmatic Expenditures	

OTHER

860,900	

233,185	124,202	108,984	860,900	-	
Acute Care - Prescription Drug Rebate Program State Match	137,191,000	45,986,400	45,730,333	256,067	137,191,000	-	
Acute Care - Prescription Drug Rebate Program Federal Authority	429,241,000	141,706,400	165,605,647	(23,899,247)	429,241,000	-	
Long Term Care - Prescription Drug Rebate Program State Match	7,578,400	2,504,300	3,283,973	(779,673)	7,578,400	-	
Long Term Care - Prescription Drug Rebate Program Federal Authority	36,422,000	12,063,400	9,698,260	2,365,140	36,422,000	-	
Proposition 204 Services - Hospital Assessment	260,723,900	103,815,700	116,102,240	(12,286,540)	260,723,900	-	
ACA Adult Expansion - Hospital Assessment	25,307,400	8,046,000	7,494,634	551,366	25,307,400	-	
Behavioral Health ACA Adult Expansion - Hospital Assessment	481,300	120,400	-	120,400	481,300	-	
Traditional Medicaid Services - TPL	194,700	65,300	258,353	(193,053)	194,700	-	
ALTCS Services - TPL	-	-	466,034	(466,034)	-	-	
ALTCS Services - Nursing Facility Assessment	108,974,800	18,679,700	20,439,493	(1,759,793)	108,974,800	-	
KidsCare Services Premiums	12,151,300	3,349,200	1,727,907	1,621,294	12,151,300	-	
Freedom to Work Premiums	31,200	-	23,110	(23,110)	31,200	-	
Crisis Services - Substance Abuse Services Fund	2,250,200	750,000	750,067	(67)	2,250,200	-	
Voluntary Political Subdivision Programs - See Note 5	 	103,147,500 	 	3,200,000 	 	3,200,000 	 	- 	 	103,147,500 	 	- 	
TOTAL OTHER EXPENDITURES	1,124,555,600	340,519,985	374,904,253	(34,384,268)	1,124,555,600	-	

TOTAL		
Administrative Expenditures	244,629,500		75,406,172		69,358,779		6,047,393		244,629,500		-	
Acute Care	10,244,204,400		3,229,161,000		3,212,292,957		16,868,043		10,244,204,400		-	
Long Term Care	 	1,544,082,800 		 	493,672,800 		 	499,014,691 		 	(5,341,891)		 	1,544,082,800 		 	- 	
TOTAL EXPENDITURES	  $	12,032,916,700 		  $	3,798,239,972 		  $	3,780,666,428 		  $	17,573,545 		  $	12,032,916,700 		  $	- 	

ARIZONA  HEALTH  CARE  COST  CONTAINMENT  SYSTEM
FY 2018 APPROPRIATION STATUS REPORT
APPROPRIATED REVENUE AND OTHER COLLECTIONS RECEIVED DETAIL SCHEDULE
For the Period Ending October 31, 2017

BUDGET

BUDGET YTD

RECEIPTS YTD

GENERAL FUND:
Traditional Medicaid Services & Administrative	$	974,581,000	$	319,319,767	$	308,179,733	
Proposition 204 Services & Administrative	21,765,400	7,107,487	49,419,075	
KidsCare Services	-	-	(84,206)	
ALTCS Services	185,064,700	61,161,600	61,688,233	
Behavioral Health Traditional Medicaid Services	 	593,913,900	 	194,075,200	 	154,265,740 	
TOTAL	1,775,325,000	581,664,055	573,468,576	

FEDERAL:
Acute & Administrative	5,868,690,400		1,853,707,033		1,802,629,747	
KidsCare Services	99,809,800		27,225,900		16,944,152	
ALTCS Services	956,062,900		311,793,300		337,682,826	
Behavioral Health Traditional Medicaid Services	 	1,693,494,500 		 	533,984,100 		 	550,689,821 	
TOTAL	8,618,057,600		2,726,710,333		2,707,946,546	

COUNTY:						
Acute & Administrative	53,343,000		17,834,700		16,122,329	
ALTCS Services	 	249,980,000 		 	87,470,500 		 	88,224,400 	
TOTAL	303,323,000		105,305,200		104,346,729	

TOBACCO FUNDS:						
Traditional Medicaid Services	72,998,200		23,947,700		24,975,023	
Proposition 204 Services	 	138,657,300 		 	20,092,700 		 	11,676,783 	
TOTAL	211,655,500		44,040,400		36,651,807	

OTHER:

Administrative	860,900		233,185		124,202	
Acute Care - Prescription Drug Rebate Program	566,432,000		187,692,800		211,335,981	
Long Term Care - Prescription Drug Rebate Program	44,000,400		14,567,700		12,982,233	
Hospital Assessment	286,512,600		111,982,100		79,282,508	
ALTCS - Nursing Facility Assessment	108,974,800		18,679,700		88,116	
Acute TPL - Note 1	194,700		65,300		258,353	
LTC TPL - Note 1	-		-		466,034	
KidsCare TPL - Note 1	-		-		(7)	
Member Premiums - CHIP	12,151,300		3,349,200		1,727,907	
Member Premiums - Freedom to Work	31,200		-		23,110	
Behavioral Health Traditional Medicaid Services	2,250,200		750,000		597,341	
Voluntary Political Subdivision - State Match	 	103,147,500 		 	3,200,000 		 	15,506,447 	
TOTAL	1,124,555,600		340,519,985		322,392,225	

TOTAL REVENUE

$	12,032,916,700

$	3,798,239,972

$	3,744,805,883

Appropriation Status Report
Footnotes

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
FY 2018 APPROPRIATION STATUS REPORT
For the Period Ending October 31, 2017	
Note 1:	Third Party Liability Collections:	October 2017		October 2016		July 1, 2017		July 1, 2016	
	Gross Collections:					October 31, 2017		October 31, 2016	
	Acute	$	355,859		$	664,628		$	2,375,706		$	1,923,244	
	LTC	407,016		500,064		2,143,581		1,509,580	
	KidsCare	69		-		697		4,878	
	Total TPL Collections	$	762,944		$	1,164,692		$	4,519,984		$	3,437,702	

AHCCCS Net Collections (Net of Federal Share): Expenditure Offsets:	
Acute	$	32,306		$	36,935		$	258,353		$	106,427		
LTC	85,890		92,240		466,034		312,585		
KidsCare	(3)		-		(7)		978		
Total Expenditure Offsets	$	118,193		$	129,175		$	724,380		$	419,990		

FY 18 Total

Note 2:    Authorized Positions	1,161.0
Actual Positions as of October 31, 2017	1,075.0

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
FY 2018 APPROPRIATION STATUS REPORT
For the Period Ending October 31, 2017

Note 3:	Intergovernmental Service Agreement - State of Hawaii:		
	Beginning Balance July 1, 2017	$	2,456,040	
	Revenues	2,555,337	
	Transfers-In	 	169,783 	
	Total Revenues	 	2,725,120 	
	Expenditures	2,138,949	
	Transfers-out	 	1,000,000 	
	Total Expenditures	 	3,138,949 	
	Ending Balance October 31, 2017	  $	2,042,211 	

Of the $2,042,211 ending balance, $1,139,010 represents restricted cash for prepaid expenses from the State of Hawaii for the projected expenditures through November 2017.

Note 4:

Summary of HHS Office of Inspector General Questioned Costs.
Schedule of Outstanding Liabilities
As of October 31, 2017
Description	Amount

School Based Claiming Direct Services Costs	19,923,489	HHS-OIG

Type

Note 5:

Summary of Voluntary Political Subdivision Contribution Expenditures:

As of October 31, 2017 Expenditures

State Match	Federal	Total

DSH Voluntary	$	-	$	-	$	-
GME Voluntary	3,200,000	7,058,054	10,258,054
Safety Net Care Pool	-	-	-

Total Voluntary Political Subdivision Program Expenditure $

3,200,000	$

7,058,054    $

10,258,054

Appropriation Status Report
Caseload and Expenditures by Rate Code

TITLE XIX TRADITIONAL

JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE

TOTAL

CAPITATION - ACUTE	285,522,617	281,333,799	282,151,301	283,135,976	0	0	0	0	0	0	0	0	1,132,143,693	
CAPITATION - LTC	206,776,494	226,817,304	208,355,352	211,447,457	0	0	0	0	0	0	0	0	853,396,607	
MENTAL HEALTH - CHILD	27,544,565	27,724,984	27,624,408	29,228,363	0	0	0	0	0	0	0	0	112,122,319	
MENTAL HEALTH - ADULT	943,019	720,852	738,314	1,280,536	0	0	0	0	0	0	0	0	3,682,721	
MENTAL HEALTH - GENERAL	12,841,280	12,960,968	12,914,296	17,193,985	0	0	0	0	0	0	0	0	55,910,529	
MENTAL HEALTH - CMDP	13,096,578	12,797,592	12,457,164	11,015,383	0	0	0	0	0	0	0	0	49,366,716	
MENTAL HEALTH - DD	4,268,444	4,283,815	4,297,906	5,700,054	0	0	0	0	0	0	0	0	18,550,219	
CHILDREN'S REHAB SERVICES	6,152,157	6,176,648	6,177,229	6,585,737	0	0	0	0	0	0	0	0	25,091,770	
FEE FOR SERVICE - ACUTE	37,517,260	57,106,521	41,373,210	36,416,482	0	0	0	0	0	0	0	0	172,413,473	
FFS - PRIOR QUARTER COVERAGE	477,647	732,384	436,709	464,159	0	0	0	0	0	0	0	0	2,110,898	
EMERGENCY SERVICES - FEDERAL	5,092,983	7,198,427	2,476,370	3,693,643	0	0	0	0	0	0	0	0	18,461,423	
FFS MEDICAID IN PUBLIC SCHOOLS	498,616	218,798	74,000	659,257	0	0	0	0	0	0	0	0	1,450,670	
QMB - FEE FOR SERVICE	489,558	701,001	415,525	457,695	0	0	0	0	0	0	0	0	2,063,778	
INPATIENT INMATES FFS	223,348	131,891	101,766	86,138	0	0	0	0	0	0	0	0	543,142	
FFS TRBHA FEE FOR SERVICE	11,064,992	13,491,379	10,597,096	9,333,252	0	0	0	0	0	0	0	0	44,486,718	
STATE ONLY TRBHA FFS	6,531	0	2,449	26,941	0	0	0	0	0	0	0	0	35,921	
PIMA COUNTY INMATES FFS	564	690	0	1,602	0	0	0	0	0	0	0	0	2,857	
PINAL COUNTY INMATES FFS	0	0	0	0	0	0	0	0	0	0	0	0	0	
MOHAVE COUNTY INMATES FFS	0	6,214	0	0	0	0	0	0	0	0	0	0	6,214	
MARICOPA CTY INMATES FFS	68,686	30,039	22,868	6,568	0	0	0	0	0	0	0	0	128,161	
YUMA COUNTY INMATES FFS	0	0	77	1,377	0	0	0	0	0	0	0	0	1,454	
FEE FOR SERVICE - LTC	11,075,900	14,779,589	11,033,723	10,412,298	0	0	0	0	0	0	0	0	47,301,511	
LFFS - PRIOR QUARTER COVERAGE	31,031	30,711	36,439	64,876	0	0	0	0	0	0	0	0	163,056	
COCHISE COUNTY INMATES LTC FFS	0	0	-980	0	0	0	0	0	0	0	0	0	-980	
MARICOPA CTY INMATES LTC FFS	166	0	607	0	0	0	0	0	0	0	0	0	772	
PIMA COUNTY INMATES LTC FEE FOR SERVICE	0	0	1,680	0	0	0	0	0	0	0	0	0	1,680	
LFFS MEDICAID IN PUBLIC SCHOOLS	1,540,502	836,850	200,804	1,208,857	0	0	0	0	0	0	0	0	3,787,013	
REINSURANCE - ACUTE	14,094,798	9,458,578	10,548,999	14,245,193	0	0	0	0	0	0	0	0	48,347,568	
REINSURANCE - LTC	8,708,155	6,429,637	7,948,066	7,110,450	0	0	0	0	0	0	0	0	30,196,308	
SMIB - ACUTE	14,841,421	15,030,410	15,054,132	15,184,273	0	0	0	0	0	0	0	0	60,110,236	
HIB - ACUTE	530,608	606,349	597,687	585,235	0	0	0	0	0	0	0	0	2,319,879	
Q1	2,585,545	2,637,260	2,661,063	2,632,237	0	0	0	0	0	0	0	0	10,516,105	
SMIB - LTC	3,694,581	3,701,005	3,714,794	3,722,089	0	0	0	0	0	0	0	0	14,832,469	
HIB - LTC	280,970	287,260	286,598	288,498	0	0	0	0	0	0	0	0	1,143,326	
SUBTOTAL	669,969,014	706,230,953	662,299,649	672,188,610	0	0	0	0	0	0	0	0	2,710,688,227	

TITLE XIX PROP 204

JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE

TOTAL

CAPITATION - ACUTE	216,118,852	215,843,745	224,050,452	228,076,092	0	0	0	0	0	0	0	0	884,089,140	
MENTAL HEALTH - CHILD	3,567	3,361	3,294	3,524	0	0	0	0	0	0	0	0	13,746	
MENTAL HEALTH - ADULT	1,025,896	887,584	796,762	1,675,620	0	0	0	0	0	0	0	0	4,385,863	
MENTAL HEALTH - GENERAL	23,612,539	23,858,290	23,761,886	31,600,038	0	0	0	0	0	0	0	0	102,832,753	
MENTAL HEALTH - CMDP	1,317	798	467	385	0	0	0	0	0	0	0	0	2,967	
CHILDREN'S REHAB SERVICES	20,262	22,004	23,504	25,762	0	0	0	0	0	0	0	0	91,532	
FEE FOR SERVICE - ACUTE	27,971,969	41,819,103	29,937,928	25,854,976	0	0	0	0	0	0	0	0	125,583,977	
FFS - PRIOR QUARTER COVERAGE	1,089,761	1,673,864	1,069,973	1,161,749	0	0	0	0	0	0	0	0	4,995,346	
FFS - PRESUMPTIVE ELIGIBILITY	607	0	10,333	113	0	0	0	0	0	0	0	0	11,053	
EMERGENCY SERVICES - FEDERAL	4,079,461	6,001,485	2,473,282	2,693,014	0	0	0	0	0	0	0	0	15,247,243	
FFS MEDICAID IN PUBLIC SCHOOLS	897	448	50	460	0	0	0	0	0	0	0	0	1,855	
INPATIENT INMATES FFS	1,021,190	712,562	351,881	689,957	0	0	0	0	0	0	0	0	2,775,591	
FFS TRBHA FEE FOR SERVICE	6,143,299	6,633,226	5,645,698	5,144,485	0	0	0	0	0	0	0	0	23,566,708	
STATE ONLY TRBHA FFS	3,266	14,268	6,531	62,345	0	0	0	0	0	0	0	0	86,411	
GRAHAM COUNTY INMATES FFS	0	0	0	71	0	0	0	0	0	0	0	0	71	
YUMA COUNTY INMATES FFS	0	0	138	1,266	0	0	0	0	0	0	0	0	1,404	
PINAL COUNTY INMATES FFS	499	0	0	0	0	0	0	0	0	0	0	0	499	
PIMA COUNTY INMATES FFS	15,143	31,906	103,883	37,867	0	0	0	0	0	0	0	0	188,800	
MARICOPA CTY INMATES FFS	265,078	189,865	92,588	121,267	0	0	0	0	0	0	0	0	668,799	
MOHAVE COUNTY INMATES FFS	0	4,601	247	8,307	0	0	0	0	0	0	0	0	13,155	
COCHISE COUNTY INMATES LTC FFS	0	1,483	0	85	0	0	0	0	0	0	0	0	1,568	
REINSURANCE - ACUTE	6,219,075	3,398,890	5,476,986	6,552,012	0	0	0	0	0	0	0	0	21,646,962	
SMIB - ACUTE	6,495,931	6,622,978	6,625,043	6,936,494	0	0	0	0	0	0	0	0	26,680,445	
HIB - ACUTE	4,563	4,976	4,150	6,215	0	0	0	0	0	0	0	0	19,904	
SUBTOTAL	294,093,172	307,725,439	300,435,075	310,652,106	0	0	0	0	0	0	0	0	1,212,905,792	

JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE
TITLE XIX ACA ADULT EXPANSION

TOTAL

CAPITATION - ACUTE	33,908,701	33,182,353	34,239,878	30,991,596	0	0	0	0	0	0	0	0	132,322,528	
MENTAL HEALTH - ADULT	50,440	101,285	73,397	91,032	0	0	0	0	0	0	0	0	316,154	
MENTAL HEALTH - GENERAL	4,449,323	4,495,516	4,484,950	6,023,406	0	0	0	0	0	0	0	0	19,453,194	
CHILDREN'S REHAB SERVICES	1,500	1,500	1,500	1,717	0	0	0	0	0	0	0	0	6,218	
FEE FOR SERVICE - ACUTE	2,634,455	3,608,952	2,850,376	2,121,538	0	0	0	0	0	0	0	0	11,215,322	
FFS - PRIOR QUARTER COVERAGE	350,598	546,221	401,753	202,324	0	0	0	0	0	0	0	0	1,500,896	
EMERGENCY SERVICES - FEDERAL	4,555,737	7,325,871	2,925,880	3,035,786	0	0	0	0	0	0	0	0	17,843,274	
FFS MEDICAID IN PUBLIC SCHOOLS	29	0	0	32	0	0	0	0	0	0	0	0	62	
INPATIENT INMATES FFS	84,703	44,767	3,220	15,529	0	0	0	0	0	0	0	0	148,220	
STATE ONLY TRBHA FFS	0	53,882	0	0	0	0	0	0	0	0	0	0	53,882	
FFS TRBHA FEE FOR SERVICE	144,138	202,842	159,014	129,200	0	0	0	0	0	0	0	0	635,194	
PIMA COUNTY INMATES FFS	594	388	6,951	1,766	0	0	0	0	0	0	0	0	9,699	
MOHAVE COUNTY INMATES FFS	0	0	11,636	0	0	0	0	0	0	0	0	0	11,636	
REINSURANCE - ACUTE	529,482	119,226	735,846	953,083	0	0	0	0	0	0	0	0	2,337,637	
SMIB - ACUTE	268	512	670	2,144	0	0	0	0	0	0	0	0	3,594	
	46,709,967	49,683,315	45,895,072	43,569,154	0	0	0	0	0	0	0	0	185,857,509	
	1,010,772,153	1,063,639,707	1,008,629,797	1,026,409,871	0	0	0	0	0	0	0	0	4,109,451,528	

SUBTOTAL TOTAL TITLE XIX
TITLE XXI KIDSCARE
MENTAL HEALTH - CHILD	36	83	0	0	0	0	0	0	0	0	0	0	119	
MENTAL HEALTH - GENERAL	-59	0	0	0	0	0	0	0	0	0	0	0	-59	
KidsCare - CAPITATION	3,237,786	3,285,902	3,386,799	3,457,322	0	0	0	0	0	0	0	0	13,367,810	
KidsCare - FEE FOR SERVICE	55,088	85,410	94,811	61,348	0	0	0	0	0	0	0	0	296,657	
KidsCare - MENTAL HEALTH	852,332	869,444	893,782	985,481	0	0	0	0	0	0	0	0	3,601,039	
KidsCare - REINSURANCE	90,334	651,642	14,877	123,660	0	0	0	0	0	0	0	0	880,512	
KidsCare - CHILD REHAB SERVICES	3,001	4,864	4,864	4,925	0	0	0	0	0	0	0	0	17,654	

4,238,517	4,897,346	4,395,133	4,632,736	0	0	0	0	0	0	0	0	18,163,732	

TOTAL TITLE XXI

1,015,010,670	1,068,537,053	1,013,024,930	1,031,042,606	0	0	0	0	0	0	0	0	4,127,615,260	

GRAND TOTAL

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017	
RATE CODE	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
1001	TANF < 1 M & F WITH	942.31	480.14	480.14	399.41	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,302.00		
1002	TANF 01-05 M & F WIT	330.04	662.35	719.38	440.97	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,152.74		
1003	TANF 06-13 M & F WIT	111.05	341.90	458.71	665.05	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,576.71		
1004	TANF 14-20 MALE WITH	-35.88	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		-35.88		
1005	TANF 14-20 FEMALE WI	127.97	652.19	536.38	798.63	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,115.17		
1006	TANF 21-44 MALE WITH	34,934.55	37,443.70	37,836.88	41,518.27	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		151,733.40		
1007	TANF 21-44 FEMALE WI	68,398.48	67,286.38	69,636.41	63,400.28	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		268,721.55		
1008	TANF 45-64 M & F WIT	98,664.26	95,156.22	95,204.68	101,155.83	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		390,180.99		
1009	TANF 65+ M & F WITH	34,339.80	38,378.47	36,415.04	33,385.65	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		142,518.96		
100E	TANF 14-20 FEMALE WI	360.46	98.29	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		458.75		
100F	TANF 21-44 MALE WITH	191.46	384.49	1,516.22	423.42	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,515.59		
100G	TANF 21-44 FEMALE WI	741.72	2,685.35	12,635.67	646.25	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		16,708.99		
100H	TANF 45-64 M & F WIT	2,193.83	5,135.99	2,741.26	1,620.46	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		11,691.54		
100J	TANF 65+ M & F WITH	1,031.55	499.92	13,829.57	17.70	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		15,378.74		
1011	TANF <1 M & F NON-ME	5,800,515.18	5,986,609.54	5,913,693.77	5,473,554.99	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		23,174,373.48		
1012	TANF 01-05 M & F NON	2,591,577.99	2,625,129.55	2,688,289.84	2,766,794.87	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		10,671,792.25		
1013	TANF 06-13 M & F NON	4,099,165.87	4,028,576.53	4,085,459.66	4,192,166.59	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		16,405,368.65		
1014	TANF 14-20 MALE NON-	1,554,134.01	1,539,972.16	1,544,371.50	1,661,651.10	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		6,300,128.77		
1015	TANF 14-20 FEMALE N O	3,181,619.83	3,154,775.67	3,179,745.51	3,187,079.99	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		12,703,221.00		
1016	TANF 21-44 MALE NON-	4,791,560.01	4,758,662.95	4,740,065.11	4,910,321.78	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		19,200,609.85		
1017	TANF 21-44 FEMALE N O	24,021,285.07	23,810,217.90	23,829,199.10	23,345,734.83	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		95,006,436.90		
1018	TANF 45-64 M & F NON	9,727,126.16	9,884,272.39	9,859,099.58	9,930,228.97	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		39,400,727.10		
1019	TANF 65+ M & F NON-M	32,576.87	37,347.94	38,137.41	38,683.50	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		146,745.72		
101A	TANF < 1 M & F NON-M	1,023,730.67	1,103,021.10	1,171,080.40	1,142,821.70	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		4,440,653.87		
101B	TANF 01-05 M & F NON	15,605.69	22,617.30	22,943.33	23,528.67	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		84,694.99		
101C	TANF 06-13 M & F NON	12,934.97	17,575.11	17,144.13	15,244.10	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		62,898.31		
101D	TANF 14-20 MALE NON-	16,158.27	8,385.64	21,451.94	17,457.85	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		63,453.70		
101E	TANF 14-20 FEMALE N O	20,152.60	9,366.17	40,491.01	28,850.16	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		98,859.94		
101F	TANF 21-44 MALE NON-	141,843.98	8,433.39	152,556.37	140,163.58	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		442,997.32		
101G	TANF 21-44 FEMALE N O	376,743.23	-38,348.88	426,120.03	412,444.58	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,176,958.96		
101H	TANF 44-64 M & F NON	127,847.88	-8,167.42	168,806.48	145,207.56	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		433,694.50		
101J	TANF 65+ N & F NON-M	771.11	-2,520.22	490.01	138.29	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		-1,120.81		
1021	TANF <1 M & F WITH Q	-2.98	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		-2.98		
1025	TANF 14-20 FEMALE WI	7.95	231.68	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		239.63		
1026	TANF 21-44 MALE WITH	23,824.71	18,670.20	20,044.84	23,179.82	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		85,719.57		
1027	TANF 21-44 FEMALE WI	63,697.04	57,779.49	61,223.61	70,083.25	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		252,783.39		

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017	
RATE CODE	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
1028	TANF 45-64 M & F WIT	68,085.21	73,049.15	74,375.63	74,220.37	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		289,730.36		
1029	TANF 65+ M & F WITH	33,210.14	34,038.26	34,639.72	40,147.57	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		142,035.69		
102F	TANF 21-44 MALE WITH	244.64	188.60	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		433.24		
102G	TANF 21-44 FEMALE WI	0.00	682.19	6,354.91	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		7,037.10		
102H	TANF 44-64 M & F WIT	0.00	2,122.59	3,329.94	57.46	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		5,509.99		
102J	TANF 65+ M & F WITH	2,351.09	0.00	3,413.37	17.36	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		5,781.82		
2100	SSI AGED WITH MEDIC A	897,693.12	795,728.25	794,596.23	725,867.13	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,213,884.73		
210Z	SSI AGED WITH MEDIC A	24,132.41	32,576.16	23,103.48	33,479.47	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		113,291.52		
2110	SSI AGED NON-MEDIC AR	6,075,643.74	5,465,504.10	5,559,965.79	6,222,835.23	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		23,323,948.86		
211Z	SSI AGED NON-MEDIC AR	82,203.22	98,950.96	116,676.00	115,811.09	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		413,641.27		
2120	SSI AGED WITH QMB	5,637,211.81	5,279,745.15	5,295,895.04	4,921,865.65	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		21,134,717.65		
212Z	SSI AGED WITH QMB P P	9,453.31	3,922.10	8,011.55	4,974.05	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		26,361.01		
2200	SSI DISABLED WITH M E	1,844,213.19	1,807,931.63	1,818,830.04	1,702,732.97	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		7,173,707.83		
220Z	SSI DISABLED WITH M E	82,731.69	79,013.24	119,166.24	98,059.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		378,970.86		
2210	SSI DISABLED NON-ME D	62,508,046.41	60,865,684.30	60,779,762.46	64,562,923.74	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		248,716,416.91		
221Z	SSI DISABLED NON-ME D	427,254.43	530,302.22	548,497.99	484,667.79	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,990,722.43		
2220	SSI DISABLED WITH Q M	16,136,563.08	15,910,270.92	15,862,362.62	15,335,746.67	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		63,244,943.29		
222Z	SSI DISABLED WITH Q M	41,384.71	50,975.23	57,078.92	39,349.72	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		188,788.58		
2300	SSI BLIND WITH MEDIC	7,950.20	7,844.97	7,916.83	7,315.45	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		31,027.45		
230Z	SSI BLIND WITH MEDIC	0.00	0.00	0.00	89.68	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		89.68		
2310	SSI BLIND NON-MEDIC A	491,202.64	477,214.81	477,129.51	522,157.03	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,967,703.99		
231Z	SSI BLIND NON-MEDIC A	11,701.90	5,145.11	4,721.06	234.51	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		21,802.58		
2320	SSI BLIND WITH QMB	53,206.29	52,023.42	52,240.26	51,818.56	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		209,288.53		
232Z	SSI BLIND WITH QMB P	76.41	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		76.41		
4301	SOBRA CHILD <1 M & F	2,382.74	1,824.46	2,230.70	-186.02	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		6,251.88		
4302	SOBRA CHILD 01-05 M	5,435.95	6,701.41	7,311.70	7,109.71	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		26,558.77		
4303	SOBRA CHILD 06-13 M	3,583.56	5,282.55	5,795.64	6,017.50	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		20,679.25		
4304	SOBRA CHILD 14-20 MA	2,430.85	2,106.43	1,995.92	1,967.31	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		8,500.51		
4305	SOBRA CHILD 14-20 FE	1,788.43	1,048.73	1,486.74	1,984.57	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		6,308.47		
430A	SOBRA CHILD < 1 M &	0.00	2,075.78	2,590.33	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		4,666.11		
430B	SOBRA CHILD 01-05 M	48.00	318.57	337.78	124.34	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		828.69		
430C	SOBRA CHILD 06-13 M	0.00	301.36	123.66	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		425.02		
430E	SOBRA CHILD 14-20 FE	0.00	126.48	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		126.48		
4311	SOBRA CHILD <1 M & F	16,404,979.48	17,089,141.08	16,931,076.40	15,617,620.11	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		66,042,817.07		
4312	SOBRA CHILD 01-05 M	23,645,128.51	23,124,722.08	22,913,119.03	22,522,535.75	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		92,205,505.37		
4313	SOBRA CHILD 06-13 M	30,350,567.88	29,716,938.60	29,496,917.65	29,186,882.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		118,751,306.82		

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017	
RATE CODE	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
4314	SOBRA CHILD 14-20 MA	10,183,859.56	9,979,977.12	9,973,198.47	10,501,457.20	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		40,638,492.35		
4315	SOBRA CHILD 14-20 FE	15,876,216.68	15,661,206.94	15,571,770.09	15,335,248.73	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		62,444,442.44		
431A	SOBRA CHILD < 1 M &	288,304.92	422,712.31	402,750.39	308,506.61	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,422,274.23		
431B	SOBRA CHILD 01-05 M	221,477.28	-7,371.32	247,293.25	228,427.78	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		689,826.99		
431C	SOBRA CHILD 6-13 M& F	216,577.94	-113,174.75	243,940.68	218,079.62	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		565,423.49		
431D	SOBRA CHILD 14-20 MA	158,371.19	-38,159.29	166,180.39	181,570.20	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		467,962.49		
431E	SOBRA CHILD 14-20 FE	207,585.75	-42,810.09	247,897.64	248,932.68	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		661,605.98		
4321	SOBRA CHILD <1 M & F	25.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		25.69		
4322	SOBRA CHILD 01-05 M	229.63	329.41	445.00	329.07	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,333.11		
4323	SOBRA CHILD 06-13 M	236.17	115.59	115.59	222.18	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		689.53		
4324	SOBRA CHILD 14-20 MA	11.50	0.00	0.00	174.93	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		186.43		
4325	SOBRA CHILD 14-20 FE	540.85	788.92	788.92	494.20	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,612.89		
5005	SOBRA PREG 14-20 FE M	508.73	207.87	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		716.60		
5007	SOBRA PREG 21-44 FE M	27,061.65	28,571.03	34,685.96	29,266.35	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		119,584.99		
5008	SOBRA PREG 45-64 FE M	3,979.99	662.69	3,748.68	3,806.17	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		12,197.53		
500G	SOBRA PREG 21-44 FE M	306.32	611.18	1,055.29	46.46	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,019.25		
500H	SOBRA PREG 45-64 FE M	771.11	0.00	0.00	153.40	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		924.51		
5013	SOBRA PREG 09-13 FE M	916.02	920.55	618.06	487.80	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,942.43		
5015	SOBRA PREG 14-20 FE M	926,061.72	932,881.49	901,144.08	866,327.64	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,626,414.93		
5017	SOBRA PREG 21-44 FE M	5,075,438.74	5,022,830.06	4,980,208.07	4,838,141.27	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		19,916,618.14		
5018	SOBRA PREG 45-64 FE M	18,556.70	17,501.16	22,231.09	22,502.28	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		80,791.23		
501C	SOBRA PREG 09-13 FE M	0.00	0.00	49.51	30.59	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		80.10		
501E	SOBRA PREG 14-20 FE M	49,647.81	-33,791.33	45,666.72	40,092.89	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		101,616.09		
501G	SOBRA PREG 21-44 FE M	202,834.23	-39,812.61	209,670.31	214,579.01	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		587,270.94		
501H	SOBRA PREG 45-64 FE M	1,185.71	329.80	1,355.77	724.65	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,595.93		
5025	SOBRA PREG 14-20 FE M	0.00	0.00	870.09	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		870.09		
5027	SOBRA PREG 21-44 FE M	24,727.60	30,213.24	24,859.62	27,645.25	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		107,445.71		
5028	SOBRA PREG 45-64 FE M	424.97	423.82	423.82	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,272.61		
502G	SOBRA PREG 21-44 FE M	6.14	744.58	44.44	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		795.16		
SUBTOTAL:	256,201,977.35	250,621,222.84	252,344,489.0	4  253,125,482.21	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,012,293,171.44		

9910	TANF & SOBRA CHILDR E	1,671,858.21	1,914,618.06	1,957,678.76	1,856,617.17	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
9920	SSI W/MEDICARE KICK	41,766.35	49,883.65	19,127.82	11,906.92	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
9921	SSI W/O MEDICARE KI C	124,693.16	188,260.19	147,522.59	133,284.96	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
9950	S.O.B.R.A. KICK PAYM	13,407,782.88	14,821,850.08	13,720,999.68	13,916,802.45	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
SUBTOTAL:	15,246,100.60	16,974,611.98	15,845,328.8	5    15,918,611.50	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	

 
7,400,772.20	
122,684.74	
593,760.90	
55,867,435.09	
63,984,652.93	

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017

RATE COD	E	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
3100	TRANSPLANT OPTION 1	0.00	0.00	16.50	16.50	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	33.00	
3200	TRANSPLANT OPTION 2	0.00	0.00	0.00	7.45	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	7.45	
320Z	TRANSPLANT OPTION 2	0.00	0.00	0.00	9.05	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	9.05	
SUBTOTAL	:	0.00	0.00	16.50	33.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	49.50	

1104	TANF EXPANDED 14-20	0.00	0.00	158.73	174.93	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1105	TANF EXPANDED 14-20	0.00	0.00	270.06	268.83	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1106	TANF EXPANDED 21-44	115,280.73	114,224.09	107,176.65	99,901.56	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1107	TANF EXPANDED 21-44	375,187.64	366,538.58	333,829.52	312,883.77	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1108	TANF EXPANDED 45-64	969,358.60	933,329.99	907,126.43	911,028.02	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1109	TANF EXPANDED 65+
M&	283,247.60	271,616.48	264,679.22	277,303.67	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
110F	TANF EXPANDED 21-44	6,434.27	833.49	9,468.54	6,982.07	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
110G	TANF EXPANDED 21-44	17,187.04	20,010.57	9,419.20	9,037.01	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
110H	TANF EXPANDED 45-64	24,588.37	18,477.98	24,383.27	28,596.40	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
110J	TANF EXPANDED 65+
M&	10,009.21	4,963.49	7,876.07	9,355.03	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1111	TANF EXPANDED <1 M
&F	49.12	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1112	TANF EXPANDED 01-05	982.24	773.49	878.63	758.18	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1113	TANF EXPANDED 06-13	7,530.15	6,396.34	6,083.16	6,244.38	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1114	TANF EXPANDED 14-20	78,885.78	74,581.55	73,294.96	73,712.88	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1115	TANF EXPANDED 14-20	480,991.35	468,272.67	461,574.87	443,197.34	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1116	TANF EXPANDED 21-44	5,205,535.87	5,124,163.45	5,063,089.09	5,186,862.33	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1117	TANF EXPANDED 21-44	20,323,286.61	19,947,918.91	19,817,865.70	19,304,901.60	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1118	TANF EXPANDED 45-64	11,730,164.19	11,843,417.41	11,798,111.08	11,837,273.32	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1119	TANF EXPANDED 65+
M&	28,256.55	28,078.55	30,516.22	27,412.94	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111C	TANF EXPANDED 06-13	87.45	0.00	45.93	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111D	TANF EXPANDED 14-20	1,869.30	-6,003.62	1,915.48	1,674.38	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111E	TANF EXPANDED 14-20	5,280.99	-9,343.89	7,162.54	5,719.16	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111F	TANF EXPANDED 21-44	113,756.88	1,485.98	145,034.89	135,400.19	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111G	TANF EXPANDED 21-44	252,045.26	-86,740.82	334,574.06	305,507.56	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111H	TANF EXPANDED 45-64	124,191.45	-46,232.92	179,167.37	182,431.81	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
111J	TANF EXPANDED 65+
M&	494.89	-2,806.54	1,682.18	476.63	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1125	TANF EXPANDED 14-20	270.06	270.06	270.06	1,205.72	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1126	TANF EXPANDED 21-44	381,006.44	383,503.97	375,635.04	374,034.86	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1127	TANF EXPANDED 21-44	1,014,812.39	1,051,819.76	1,052,061.48	1,016,145.12	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1128	TANF EXPANDED 45-64	1,418,896.68	1,476,267.90	1,509,810.12	1,527,375.53	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
1129	TANF EXPANDED 65+
M&	495,757.35	518,707.26	541,252.62	561,486.54	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	

333.66	
538.89	
436,583.03	
1,388,439.51	
3,720,843.04	
1,096,846.97	
23,718.37	
55,653.82	
96,046.02	
32,203.80	
49.12	
3,392.54	
26,254.03	
300,475.17	
1,854,036.23	
20,579,650.74	
79,393,972.82	
47,208,966.00	
114,264.26	
133.38	
-544.46	
8,818.80	
395,677.94	
805,386.06	
439,557.71	
-152.84	
2,015.90	
1,514,180.31	
4,134,838.75	
5,932,350.23	
2,117,203.77	

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017	
RATE CODE	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
112F	TANF EXPANDED 21-44	1,142.03	-462.10	2,378.99	359.92	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,418.84		
112G	TANF EXPANDED 21-44	3,902.35	1,608.95	3,029.33	2,326.19	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		10,866.82		
112H	TANF EXPANDED 45-64	1,484.83	1,137.12	1,998.70	1,851.38	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		6,472.03		
112J	TANF EXPANDED 65+
M&	590.21	399.74	2,833.62	1,576.59	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		5,400.16		
2400	SSI AGED EXPANDED WI	70,982.22	60,953.05	42,379.02	46,696.54	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		221,010.83		
240Z	SSI AGED EXPANDED WI	13,292.73	18,104.44	15,345.34	24,325.63	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		71,068.14		
2410	SSI AGED EXPANDED NO	111,573.31	93,539.30	90,400.82	98,575.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		394,089.12		
241Z	SSI AGED EXPANDED NO	3,594.96	4,633.83	2,444.93	4,077.94	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		14,751.66		
2420	SSI AGED EXPANDED WI	5,048,533.15	4,858,902.19	4,913,101.54	4,612,001.82	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		19,432,538.70		
242Z	SSI AGED EXPANDED WI	5,768.70	2,945.99	16,003.17	14,030.03	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		38,747.89		
2500	SSI BLIND EXPANDED W	439.11	167.67	167.67	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		774.45		
2510	SSI BLIND EXPANDED N	106.76	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		106.76		
2520	SSI BLIND EXPANDED W	171.43	125.89	125.89	117.27	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		540.48		
2600	SSI DISABLED EXPAND E	215,717.42	190,692.83	143,975.61	144,233.09	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		694,618.95		
260Z	SSI DISABLED EXPAND E	68,640.56	81,350.26	74,884.42	54,167.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		279,042.54		
2610	SSI DISABLED EXPAND E	2,036,765.94	1,767,448.42	1,732,155.12	1,816,796.57	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		7,353,166.05		
261Z	SSI DISABLED EXPAND E	24,058.45	27,936.64	20,953.50	19,905.37	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		92,853.96		
2620	SSI DISABLED EXPAND E	11,145,576.62	11,100,954.59	11,163,780.13	10,873,351.37	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		44,283,662.71		
262Z	SSI DISABLED EXPAND E	17,013.33	40,720.31	38,407.28	26,846.32	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		122,987.24		
SUBTOTAL:	62,234,798.57	60,755,683.30	61,328,778.2	5    60,388,590.78	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		244,707,850.90		

3504	ADULT 40-100% MALE
1	4.57	524.57	524.57	553.98	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3505	ADULT 40-100% FEMAL E	11.28	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3506	ADULT 40-100% MALE
2	1,596.06	462.79	0.00	720.24	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3507	ADULT 40-100% FEMAL E	1,621.87	6,170.00	4,866.99	9,254.66	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3508	ADULT 40-100% M&F 45	11,510.40	24,329.60	21,298.00	26,618.79	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3509	ADULT 40-100% M&F 65	-269.59	0.00	0.00	1,472.99	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
350F	ADULT 40-100% MALE
2	2,884.85	0.00	0.00	2,861.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
350G	ADULT 40-100% FEMAL E	1,153.34	348.18	394.77	1,198.32	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
350H	ADULT 40-100% M&F 45	3,127.80	5,761.37	2,912.68	2,885.39	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3514	ADULT 40-100% MALE
1	2,852,736.53	2,959,028.68	2,950,540.46	3,095,879.33	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3515	ADULT 40-100% FEMAL E	3,023,174.20	3,119,177.27	3,125,850.76	3,253,116.96	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3516	ADULT 40-100% MALE
2	9,879,165.10	10,570,723.64	10,548,405.86	10,927,959.59	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	

1,607.69	
11.28	
2,779.09	
21,913.52	
83,756.79	
1,203.40	
5,746.54	
3,094.61	
14,687.24	
11,858,185.00	
12,521,319.19	
41,926,254.19	

9911	SB PAYMENT FOR TAN F	1,371,150.11	1,352,929.38	1,351,432.00	1,406,467.25	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
9922	SB PAYMENT FOR SSI E	0.00	12,759.89	5,501.04	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
SUBTOTAL:	1,371,150.11	1,365,689.27	1,356,933.04	1,406,467.25	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	

 
5,481,978.74	
18,260.93	
5,500,239.67	

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017	
RATE CODE	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
3517	ADULT 40-100% FEMAL E	8,205,716.71	8,796,499.02	8,762,939.55	9,073,866.24	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		34,839,021.52		
3518	ADULT 40-100% M&F 45	18,927,504.84	20,154,964.40	20,141,357.27	20,772,060.93	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		79,995,887.44		
3519	ADULT 40-100% M&F 65	7,808.53	9,609.66	9,072.99	8,219.85	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		34,711.03		
351D	ADULT 40-100% MALE
1	72,359.73	-49,736.72	80,177.67	90,718.82	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		193,519.50		
351E	ADULT 40-100% FEMAL E	63,306.58	-18,704.27	100,820.64	106,094.12	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		251,517.07		
351F	ADULT 40-100% MALE
2	291,967.08	8,303.19	382,394.37	506,730.64	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,189,395.28		
351G	ADULT 40-100% FEMAL E	229,537.12	-11,995.73	276,148.64	401,727.43	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		895,417.46		
351H	ADULT 40-100% M&F 45	545,163.08	-65,763.05	672,288.35	733,547.24	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,885,235.62		
351J	ADULT 40-100% M&F 65	11,658.82	-3,539.60	6,745.90	2,698.36	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		17,563.48		
3525	ADULT 40-100% FEMAL E	0.00	0.00	524.57	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		524.57		
3526	ADULT 40-100% MALE
2	396.51	461.32	0.00	1,567.86	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,425.69		
3527	ADULT 40-100% FEMAL E	-9.13	2,368.59	588.95	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,948.41		
3528	ADULT 40-100% M&F 45	2,052.47	4,019.10	2,334.56	3,376.73	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		11,782.86		
3529	ADULT 40-100% M&F 65	354.63	904.71	904.71	920.35	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,084.40		
352F	ADULT 40-100% MALE
2	0.00	0.00	0.00	1,787.76	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,787.76		
352G	ADULT 40-100% FEMAL E	0.00	0.00	629.62	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		629.62		
352H	ADULT 40-100% M&F 45	2,162.61	2,114.04	1,195.90	800.70	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		6,273.25		
3704	ADULT <40% EXP MAL E	18.53	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		18.53		
3706	ADULT <40% EXP MAL E	6,494.13	11,445.31	9,607.38	12,433.27	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		39,980.09		
3707	ADULT <40% EXP FEM AL	4,432.57	11,559.30	6,367.71	7,094.37	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		29,453.95		
3708	ADULT <40% EXP M&F 4	14,067.06	21,252.76	18,772.50	14,330.47	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		68,422.79		
3709	ADULT <40% EXP M&F 6	1,019.42	923.08	871.58	982.73	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,796.81		
370F	ADULT <40% EXP MAL E	3,252.78	4,082.51	7,058.09	6,313.54	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		20,706.92		
370G	ADULT <40% EXP FEM AL	4,275.36	-105.36	5,092.91	9,867.05	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		19,129.96		
370H	ADULT <40% EXP M&F 4	20,886.74	12,971.24	6,421.61	8,779.28	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		49,058.87		
3714	ADULT <40% EXP MAL E	5,219,470.41	5,394,579.02	5,348,920.56	5,535,933.27	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		21,498,903.26		
3715	ADULT <40% EXP FEM AL	4,642,825.69	4,808,976.61	4,806,346.81	4,987,249.65	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		19,245,398.76		
3716	ADULT <40% EXP MAL E	33,047,874.79	34,761,629.62	34,524,197.29	35,574,569.16	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		137,908,270.86		
3717	ADULT <40% EXP FEM AL	20,320,142.05	21,465,807.39	21,299,025.95	21,846,235.51	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		84,931,210.90		
3718	ADULT <40% EXP M&F 4	40,004,359.73	42,354,058.71	42,136,406.97	43,399,233.07	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		167,894,058.48		
3719	ADULT <40% EXP M&F 6	15,351.84	18,714.38	19,589.72	18,168.12	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		71,824.06		
371D	ADULT <40% EXP MAL E	146,006.19	-155,374.60	185,124.87	197,311.49	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		373,067.95		
371E	ADULT <40% EXP FEM AL	144,773.10	-80,125.65	177,307.87	167,619.03	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		409,574.35		
371F	ADULT <40% EXP MAL E	1,612,184.26	-543,288.27	2,042,350.13	2,001,974.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		5,113,220.81		
371G	ADULT <40% EXP FEM AL	963,473.42	-72,313.27	1,067,613.64	1,040,834.98	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,999,608.77		
371H	ADULT <40% EXP M&F 4	1,422,746.28	-670,271.54	1,758,693.90	1,680,863.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		4,192,032.33		

ACUTE CAPITATION - AMOUNTS
For The Period Ending October 31, 2017	
RATE CODE	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
371J	ADULT <40% EXP M&F 6	3,132.07	6,682.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		9,814.76		
3724	ADULT <40% EXP MAL E	-6.26	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		-6.26		
3725	ADULT <40% EXP FEM AL	4.46	870.09	870.09	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		1,744.64		
3726	ADULT <40% EXP MAL E	6,441.63	3,337.56	1,346.03	1,105.89	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		12,231.11		
3727	ADULT <40% EXP FEM AL	251.87	0.00	2,368.59	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		2,620.46		
3728	ADULT <40% EXP M&F 4	5,999.63	7,782.84	2,534.43	3,653.75	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		19,970.65		
3729	ADULT <40% EXP M&F 6	448.69	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		448.69		
372F	ADULT <40% EXP MAL E	388.35	883.02	1,708.96	404.92	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		3,385.25		
372H	ADULT <40% EXP M&F 4	997.14	5,797.76	1,631.10	995.10	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		9,421.10		
SUBTOTAL:	151,748,007.92	152,885,905.96	160,523,146.4	7  165,542,592.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00		630,699,652.35		

3904	NEWLY ELIGIBLE MALE	2.95	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3905	NEWLY ELIGIBLE FEMA L	-11.24	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3906	NEWLY ELIGIBLE MALE	955.33	2,177.61	1,713.76	6,849.46	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3907	NEWLY ELIGIBLE FEMA L	1,508.51	1,425.48	384.66	2,767.98	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3908	NEWLY ELIGIBLE M&F 4	18,149.81	56,587.27	63,915.79	52,735.29	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3909	NEWLY ELIGIBLE M&F 6	2,088.17	2,354.00	3,936.23	3,496.07	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
390F	NEWLY ELIGIBLE MALE	0.00	496.06	436.82	902.36	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
390G	NEWLY ELIGIBLE FEMA L	407.87	99.21	0.00	1,261.76	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
390H	NEWLY ELIGIBLE M&F 4	0.00	838.99	227.82	2,481.75	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
390J	NEWLY ELIGIBLE M&F 6	224.85	0.00	0.00	36.91	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3914	NEWLY ELIGIBLE MALE	1,273,793.61	1,294,010.36	1,305,654.15	1,187,391.63	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3915	NEWLY ELIGIBLE FEMA L	1,443,708.45	1,452,256.31	1,476,486.79	1,344,916.08	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3916	NEWLY ELIGIBLE MALE	7,793,548.62	7,828,522.86	7,778,229.06	6,951,268.30	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3917	NEWLY ELIGIBLE FEMA L	10,614,962.26	10,780,139.03	10,723,337.18	9,605,049.04	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3918	NEWLY ELIGIBLE M&F 4	11,600,013.20	11,586,923.15	11,546,535.64	10,318,104.53	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
3919	NEWLY ELIGIBLE M&F 6	5,388.09	5,528.23	6,730.06	5,862.78	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
391D	NEWLY ELIGIBLE MALE	24,013.79	-12,675.48	27,045.58	33,208.81	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
391E	NEWLY ELIGIBLE FEMA L	29,024.73	-17,035.99	37,880.29	40,869.16	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
391F	NEWLY ELIGIBLE MALE	207,852.91	-68,573.75	225,723.91	265,705.36	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
391G	NEWLY ELIGIBLE FEMA L	258,501.92	-57,783.27	316,354.94	368,105.10	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
391H	NEWLY ELIGIBLE M&F 4	202,007.44	-538.24	257,708.46	347,676.97	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
391J	NEWLY ELIGIBLE M&F 6	2,782.92	341.73	573.08	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	

2.95	
-11.24	
11,696.16	
6,086.63	
191,388.16	
11,874.47	
1,835.24	
1,768.84	
3,548.56	
261.76	
5,060,849.75	
5,717,367.63	
30,351,568.84	
41,723,487.51	
45,051,576.52	
23,509.16	
71,592.70	
90,738.19	
630,708.43	
885,178.69	
806,854.63	
3,697.73	

9935	BIRTH SUPP PAYMENT A	276,810.08	265,656.53	276,630.88	193,528.66	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
9937	BIRTH SUPP PAYMENT A	488,085.14	570,809.95	564,963.00	544,913.16	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
SUBTOTAL:	764,895.22	836,466.48	841,593.8	8	738,441.82	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	

 
1,012,626.15	
2,168,771.25	
3,181,397.40	

RATE COD	E	DESCRIPTION	JULY	AUGUST	SEPTEMBER	OCTOBER	NOVEMBER	DECEMBER	JANUARY	FEBRUARY	MARCH	APRIL	MAY	JUNE	TOTAL	
3926	NEWLY ELIGIBLE MALE	1,466.71	2,601.42	360.88	307.45	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	4,736.46	
3927	NEWLY ELIGIBLE FEMA L	390.74	0.00	0.00	2,363.74	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	2,754.48	
3928	NEWLY ELIGIBLE M&F 4	824.99	1,840.92	2,321.11	2,412.22	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	7,399.24	
3929	NEWLY ELIGIBLE M&F 6	83.77	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	83.77	
392F	NEWLY ELIGIBLE MALE	3,285.46	99.83	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	3,385.29	
392H	NEWLY ELIGIBLE M&F 4	110.24	402.87	284.78	24.61	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	822.50	
SUBTOTAL	:	33,485,086.10	32,860,038.60	33,775,840.99	30,543,797.36	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	130,664,763.05	

4403	SOBRA 100-133% M&F
6	794.23	905.88	826.73	816.49	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
4404	SOBRA 100-133% MALE	326.61	315.23	315.23	325.15	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	
4405	SOBRA 100-133% FEM AL	757.74