<aside> đź“” Table of Contents


Table VIII-1. 2024 CMS-HCC Model Relative Factors for Continuing Enrollees

| Variable | Description Label | Community, NonDual, Aged | Community, NonDual, Disabled | Community, FBDual, Aged | Community, FBDual, Disabled | Community, PBDual, Aged | Community, PBDual, Disabled | Institutional | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Female | | | | | | | | | | 0-34 Years | | - | 0.238 | - | 0.346 | - | 0.454 | 0.948 | | 35-44 Years | | - | 0.288 | - | 0.332 | - | 0.420 | 0.810 | | 45-54 Years | | - | 0.340 | - | 0.384 | - | 0.404 | 1.031 | | 55-59 Years | | - | 0.385 | - | 0.421 | - | 0.424 | 0.949 | | 60-64 Years | | - | 0.436 | - | 0.502 | - | 0.414 | 0.881 | | 65-69 Years | | 0.330 | - | 0.435 | - | 0.365 | - | 1.188 | | 70-74 Years | | 0.395 | - | 0.506 | - | 0.423 | - | 1.119 | | 75-79 Years | | 0.465 | - | 0.596 | - | 0.485 | - | 0.965 | | 80-84 Years | | 0.524 | - | 0.665 | - | 0.544 | - | 0.862 | | 85-89 Years | | 0.624 | - | 0.775 | - | 0.618 | - | 0.750 | | 90-94 Years | | 0.737 | - | 0.869 | - | 0.738 | - | 0.627 | | 95 Years or Over | | 0.742 | - | 0.877 | - | 0.835 | - | 0.481 | | Male | | | | | | | | | | 0-34 Years | | - | 0.106 | - | 0.191 | - | 0.306 | 0.826 | | 35-44 Years | | - | 0.154 | - | 0.204 | - | 0.261 | 0.719 | | 45-54 Years | | - | 0.215 | - | 0.293 | - | 0.300 | 0.991 | | 55-59 Years | | - | 0.283 | - | 0.410 | - | 0.353 | 0.989 | | 60-64 Years | | - | 0.345 | - | 0.504 | - | 0.374 | 0.917 | | 65-69 Years | | 0.332 | - | 0.531 | - | 0.375 | - | 1.275 | | 70-74 Years | | 0.396 | - | 0.626 | - | 0.417 | - | 1.224 | | 75-79 Years | | 0.502 | - | 0.714 | - | 0.498 | - | 1.319 | | 80-84 Years | | 0.571 | - | 0.789 | - | 0.565 | - | 1.238 | | 85-89 Years | | 0.664 | - | 0.907 | - | 0.615 | - | 1.135 | | 90-94 Years | | 0.800 | - | 0.993 | - | 0.712 | - | 0.946 | | 95 Years or Over | | 0.896 | - | 1.058 | - | 0.904 | - | 0.825 | | Medicaid and Originally Disabled Interactions | | | | | | | | | | Originally Disabled, Female | 0.228 | - | 0.160 | - | 0.103 | - | - | | | Originally Disabled, Male | 0.135 | - | 0.158 | - | 0.075 | - | - | | | Medicaid | - | - | - | - | - | - | 0.130 | |

| Variable | Description Label | Community, NonDual, Aged | Community, NonDual, Disabled | Community, FBDual, Aged | Community, FBDual, Disabled | Community, PBDual, Aged | Community, PBDual, Disabled | Institutional | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Disease Coefficients | | | | | | | | | | HCC1 | HIV/AIDS | 0.301 | 0.213 | 0.397 | 0.237 | 0.196 | 0.109 | 1.322 | | HCC2 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | 0.500 | 0.598 | 0.649 | 0.780 | 0.447 | 0.591 | 0.605 | | HCC6 | Opportunistic Infections | 0.381 | 0.763 | 0.588 | 0.833 | 0.518 | 0.685 | 0.728 | | HCC17 | Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic | 4.209 | 3.995 | 3.896 | 4.235 | 3.946 | 4.103 | 1.952 | | HCC18 | Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid | 2.341 | 2.486 | 2.277 | 2.537 | 2.166 | 2.403 | 1.110 | | HCC19 | Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers | 1.798 | 1.989 | 1.563 | 1.661 | 1.520 | 1.554 | 0.957 | | HCC20 | Lung and Other Severe Cancers | 1.136 | 0.978 | 1.166 | 1.173 | 1.214 | 1.067 | 0.672 | | HCC21 | Lymphoma and Other Cancers | 0.671 | 0.540 | 0.654 | 0.739 | 0.627 | 0.618 | 0.493 | | HCC22 | Bladder, Colorectal, and Other Cancers | 0.363 | 0.366 | 0.382 | 0.409 | 0.410 | 0.351 | 0.314 | | HCC23 | Prostate, Breast, and Other Cancers and Tumors | 0.186 | 0.233 | 0.196 | 0.218 | 0.203 | 0.237 | 0.197 | | HCC35 | Pancreas Transplant Status | 0.949 | 1.393 | 1.117 | 0.573 | 1.117 | 2.740 | 1.106 | | HCC36 | Diabetes with Severe Acute Complications | 0.166 | 0.191 | 0.186 | 0.235 | 0.166 | 0.210 | 0.280 | | HCC37 | Diabetes with Chronic Complications | 0.166 | 0.191 | 0.186 | 0.235 | 0.166 | 0.210 | 0.280 | | HCC38 | Diabetes with Glycemic, Unspecified, or No Complications | 0.166 | 0.191 | 0.186 | 0.235 | 0.166 | 0.210 | 0.280 | | HCC48 | Morbid Obesity | 0.186 | 0.144 | 0.300 | 0.178 | 0.164 | 0.118 | 0.442 | | HCC49 | Specified Lysosomal Storage Disorders | 9.256 | 13.778 | 2.833 | 6.399 | 3.269 | 7.771 | 1.528 |

| Variable | Description Label | Community, NonDual, Aged | Community, NonDual, Disabled | Community, FBDual, Aged | Community, FBDual, Disabled | Community, PBDual, Aged | Community, PBDual, Disabled | Institutional | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | HCC50 | Amyloidosis, Porphyria, and Other Specified Metabolic Disorders | 0.648 | 0.883 | 0.555 | 0.789 | 0.435 | 0.529 | 0.362 | | HCC51 | Addison's and Cushing's Diseases, Acromegaly, and Other Specified Endocrine Disorders | 0.510 | 0.606 | 0.634 | 0.654 | 0.313 | 0.393 | 0.620 | | HCC62 | Liver Transplant Status/Complications | 0.376 | 0.184 | 0.261 | 0.409 | 0.571 | 0.271 | 0.593 | | HCC63 | Chronic Liver Failure/End- Stage Liver Disorders | 0.962 | 1.032 | 1.102 | 1.209 | 0.861 | 1.101 | 0.894 | | HCC64 | Cirrhosis of Liver | 0.447 | 0.383 | 0.475 | 0.414 | 0.391 | 0.270 | 0.378 | | HCC65 | Chronic Hepatitis | 0.185 | 0.248 | 0.101 | 0.220 | 0.156 | 0.189 | 0.378 | | HCC68 | Cholangitis and Obstruction of Bile Duct Without Gallstones | 0.388 | 0.383 | 0.085 | 0.354 | 0.391 | 0.270 | 0.090 | | HCC77 | Intestine Transplant Status/Complications | 1.172 | 6.301 | 5.039 | 6.161 | 5.039 | 5.039 | 5.089 | | HCC78 | Intestinal Obstruction/Perforation | 0.326 | 0.534 | 0.382 | 0.548 | 0.478 | 0.688 | 0.380 | | HCC79 | Chronic Pancreatitis | 0.357 | 0.574 | 0.525 | 0.799 | 0.444 | 0.709 | 0.218 | | HCC80 | Crohn's Disease (Regional Enteritis) | 0.550 | 0.635 | 0.490 | 0.651 | 0.479 | 0.603 | 0.374 | | HCC81 | Ulcerative Colitis | 0.244 | 0.285 | 0.201 | 0.286 | 0.205 | 0.237 | 0.258 | | HCC92 | Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis | 0.479 | 0.529 | 0.611 | 0.632 | 0.471 | 0.539 | 0.556 | | HCC93 | Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders | 0.617 | 0.470 | 0.439 | 0.384 | 0.405 | 0.288 | 0.297 | | HCC94 | Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders | 0.268 | 0.239 | 0.237 | 0.250 | 0.224 | 0.196 | 0.297 | | HCC107 | Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero | 0.457 | 1.449 | 0.610 | 1.939 | 0.303 | 1.569 | 0.692 |

| Variable | Description Label | Community, NonDual, Aged | Community, NonDual, Disabled | Community, FBDual, Aged | Community, FBDual, Disabled | Community, PBDual, Aged | Community, PBDual, Disabled | Institutional | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | HCC108 | Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major | 0.146 | 0.386 | 0.103 | 0.408 | 0.303 | 0.416 | 0.098 | | HCC109 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | 1.144 | 1.815 | 1.048 | 1.541 | 1.009 | 1.514 | 0.529 | | HCC111 | Hemophilia, Male | 4.639 | 30.706 | 15.539 | 31.424 | 11.201 | 32.199 | 6.310 | | HCC112 | Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions | 0.450 | 0.640 | 0.460 | 0.634 | 0.574 | 0.708 | 0.516 | | HCC114 | Common Variable and Combined Immunodeficiencies | 2.262 | 2.598 | 2.016 | 2.670 | 2.137 | 2.789 | 0.691 | | HCC115 | Specified Immunodeficiencies and White Blood Cell Disorders | 0.565 | 0.692 | 0.438 | 0.498 | 0.302 | 0.613 | 0.691 | | HCC125 | Dementia, Severe | 0.341 | 0.296 | 0.438 | 0.367 | 0.401 | 0.345 | - | | HCC126 | Dementia, Moderate | 0.341 | 0.296 | 0.438 | 0.367 | 0.401 | 0.345 | - | | HCC127 | Dementia, Mild or Unspecified | 0.341 | 0.296 | 0.438 | 0.367 | 0.401 | 0.345 | - | | HCC135 | Drug Use with Psychotic Complications | 0.424 | 0.637 | 0.702 | 1.181 | 0.522 | 0.922 | 0.297 | | HCC136 | Alcohol Use with Psychotic Complications | 0.424 | 0.637 | 0.502 | 1.181 | 0.522 | 0.922 | 0.297 | | HCC137 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 0.424 | 0.365 | 0.502 | 0.471 | 0.394 | 0.348 | 0.297 | | HCC138 | Drug Use Disorder, Mild, Uncomplicated, Except Cannabis | 0.423 | 0.264 | 0.502 | 0.384 | 0.355 | 0.348 | 0.297 | | HCC139 | Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified NonPsychotic Complications | 0.242 | 0.207 | 0.478 | 0.250 | 0.308 | 0.159 | - |

| Variable | Description Label | Community, NonDual, Aged | Community, NonDual, Disabled | Community, FBDual, Aged | Community, FBDual, Disabled | Community, PBDual, Aged | Community, PBDual, Disabled | Institutional | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | HCC151 | Schizophrenia | 0.511 | 0.380 | 0.591 | 0.414 | 0.501 | 0.304 | 0.449 | | HCC152 | Psychosis, Except Schizophrenia | 0.484 | 0.290 | 0.579 | 0.255 | 0.501 | 0.247 | 0.208 | | HCC153 | Personality Disorders; Anorexia/Bulimia Nervosa | 0.396 | 0.290 | 0.420 | 0.255 | 0.464 | 0.232 | 0.199 | | HCC154 | Bipolar Disorders without Psychosis | 0.351 | 0.166 | 0.349 | 0.126 | 0.314 | 0.108 | 0.199 | | HCC155 | Major Depression, Moderate or Severe, without Psychosis | 0.299 | 0.166 | 0.316 | 0.126 | 0.269 | 0.108 | 0.199 | | HCC180 | Quadriplegia | 1.125 | 0.986 | 1.068 | 1.095 | 1.311 | 1.399 | 0.735 | | HCC181 | Paraplegia | 0.942 | 0.648 | 0.859 | 0.832 | 0.883 | 0.852 | 0.563 | | HCC182 | Spinal Cord Disorders/Injuries | 0.478 | 0.368 | 0.402 | 0.308 | 0.401 | 0.316 | 0.270 | | HCC190 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy | 1.175 | 1.792 | 1.427 | 3.642 | 0.640 | 1.243 | 0.628 | | HCC191 | Quadriplegic Cerebral Palsy | 0.855 | 0.743 | 0.393 | 0.466 | 0.840 | 0.104 | - | | HCC192 | Cerebral Palsy, Except Quadriplegic | 0.314 | 0.129 | - | 0.067 | 0.220 | 0.104 | - | | HCC193 | Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor Neuropathy | 1.692 | 1.427 | 0.957 | 0.939 | 1.149 | 0.850 | 0.913 | | HCC195 | Myasthenia Gravis with (Acute) Exacerbation | 2.909 | 3.633 | 2.153 | 3.323 | 2.690 | 1.779 | 1.837 | | HCC196 | Myasthenia Gravis without (Acute) Exacerbation and Other Myoneural Disorders | 0.516 | 0.642 | 0.503 | 0.507 | 0.427 | 0.248 | 0.486 | | HCC197 | Muscular Dystrophy | 0.426 | 0.632 | 0.369 | 0.681 | 0.162 | 0.145 | 0.292 | | HCC198 | Multiple Sclerosis | 0.647 | 0.908 | 0.791 | 1.143 | 0.569 | 0.770 | 0.226 | | HCC199 | Parkinson and Other Degenerative Disease of Basal Ganglia | 0.615 | 0.517 | 0.634 | 0.504 | 0.474 | 0.354 | 0.219 |

| Variable | Description Label | Community, NonDual, Aged | Community, NonDual, Disabled | Community, FBDual, Aged | Community, FBDual, Disabled | Community, PBDual, Aged | Community, PBDual, Disabled | Institutional | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | HCC200 | Friedreich and Other Hereditary Ataxias; Huntington Disease | 0.279 | 0.208 | 0.165 | 0.281 | 0.050 | 0.428 | - | | HCC201 | Seizure Disorders and Convulsions | 0.245 | 0.196 | 0.233 | 0.170 | 0.245 | 0.202 | 0.131 | | HCC202 | Coma, Brain Compression/Anoxic Damage | 0.543 | 0.238 | 0.721 | 0.279 | 0.549 | 0.309 | 0.097 | | HCC211 | Respirator Dependence/Tracheostomy Status/Complications | 0.879 | 0.878 | 1.981 | 1.418 | 1.022 | 0.590 | 1.570 | | HCC212 | Respiratory Arrest | 0.370 | 0.510 | 0.573 | 0.662 | 0.409 | 0.493 | 0.258 | | HCC213 | Cardio-Respiratory Failure and Shock | 0.370 | 0.510 | 0.573 | 0.662 | 0.409 | 0.493 | 0.258 | | HCC221 | Heart Transplant Status/Complications | 1.053 | 0.999 | 1.412 | 1.781 | 0.880 | 1.371 | 0.840 | | HCC222 | End-Stage Heart Failure | 2.505 | 5.770 | 2.927 | 6.612 | 3.009 | 6.106 | 0.826 | | HCC223 | Heart Failure with Heart Assist Device/Artificial Heart | 2.505 | 5.770 | 2.927 | 6.612 | 3.009 | 6.106 | 0.826 | | HCC224 | Acute on Chronic Heart Failure | 0.360 | 0.442 | 0.406 | 0.537 | 0.311 | 0.411 | 0.217 | | HCC225 | Acute Heart Failure (Excludes Acute on Chronic) | 0.360 | 0.442 | 0.406 | 0.537 | 0.311 | 0.411 | 0.217 | | HCC226 | Heart Failure, Except End- Stage and Acute | 0.360 | 0.442 | 0.406 | 0.537 | 0.311 | 0.411 | 0.217 | | HCC227 | Cardiomyopathy/Myocarditis | 0.189 | 0.200 | 0.173 | 0.198 | 0.145 | 0.186 | 0.189 | | HCC228 | Acute Myocardial Infarction | 0.252 | 0.254 | 0.493 | 0.517 | 0.324 | 0.407 | 0.310 | | HCC229 | Unstable Angina and Other Acute Ischemic Heart Disease | 0.240 | 0.254 | 0.325 | 0.458 | 0.278 | 0.315 | 0.310 | | HCC238 | Specified Heart Arrhythmias | 0.299 | 0.296 | 0.407 | 0.304 | 0.293 | 0.261 | 0.245 | | HCC248 | Intracranial Hemorrhage | 0.239 | 0.180 | 0.377 | 0.332 | 0.313 | 0.183 | 0.081 | | HCC249 | Ischemic or Unspecified Stroke | 0.239 | 0.180 | 0.377 | 0.277 | 0.299 | 0.172 | 0.081 | | HCC253 | Hemiplegia/Hemiparesis | 0.387 | 0.320 | 0.437 | 0.390 | 0.437 | 0.403 | - | | HCC254 | Monoplegia, Other Paralytic Syndromes | 0.321 | 0.172 | 0.292 | 0.365 | 0.290 | 0.335 | - |

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NOTES:

  1. The denominator used is [$10,402.34](https://10,402.34/).
  2. In the “disease interactions” and “disabled interactions,” the variables are defined as follows:

SOURCE: 2018-2019 100% Medicare data.

Table VIII-2. 2024 CMS-HCC Model Relative Factors for Aged and Disabled New Enrollees

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