States' Oversight of Medicaid Managed Care Medical Loss Ratios

Medical loss ratio (MLR) requirements in Medicaid managed care are a method to address State and Federal concerns about the growth in Medicaid spending. Federal MLR requirements are intended to ensure that Medicaid managed care plans spend the majority of the Medicaid capitation payments that they receive from the State on beneficiaries' medical care rather than on administration and profit. Pursuant to the May 2016 Medicaid managed care final rule, States must include requirements in managed care plan contracts for plans to collect MLR data, calculate an MLR percentage, and report that percentage and related, underlying data to the State. States' collection of complete and accurate MLR data from their managed care plans is a critical first step for determining Medicaid managed care MLR performance nation-wide. Complete and accurate MLR data will also enable States to set appropriate managed care payment rates to control Medicaid costs. This work will provide timely, nation-wide data on MLR performance in Medicaid managed care and identify the actions that States have taken to ensure the completeness and accuracy of their managed care plans' MLR data.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
April 2020	Centers for Medicare and Medicaid Services	States' Oversight of Medicaid Managed Care Medical Loss Ratios	Office of Evaluation and Inspections	OEI-03-20-00230	2021