Medicaid Managed Care Frequently Asked Questions (FAQs) - Medical Loss Ratio

Medicaid Managed Care Frequently Asked Questions (FAQs) - Medical Loss Ratio

Today, the Centers for Medicare & Medicaid Services (CMS) issued a Medicaid Informational Bulletin that provides guidance to states on the implementation and compliance requirements of the Medical Loss Ratio (MLR) that should be included in their Medicaid managed care contracts.  States are required to include requirements for managed care plans to calculate and report an MLR. 

These requirements were established under the 2016 Medicaid managed care regulations for contracts that started on or after July 1, 2017.  Additionally, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) added statutory requirements to encourage the use of remittances if a managed care plan does not meet a minimum MLR of at least 85 percent.

• CIB: Medicaid Managed Care Frequently Asked Questions