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Review of South Carolina's Medicaid Managed Care Program Potential Savings With Minimum Medical Loss Ratio

South Carolina's Medicaid managed care program would not have saved any Medicaid funds in calendar year (CY) 2014 if the State agency had (1) required its Medicaid managed care plans to meet the minimum medical loss ratio (MLR) standard similar to the Federal standards for certain private health insurers and Medicare Advantage plans and (2) required remittances when Medicaid managed care plans did not meet the MLR standard. Specifically, all of the six managed care plans that we reviewed had MLRs greater than 85 percent (the minimum MLR standard for large private insurers) during CY 2014.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201