Medicaid Managed Care: CMS's Oversight of Whether States Return the Required Federal Share of Medical Loss Ratio Remittances

With its 2016 Medicaid managed care regulations, CMS established medical loss ratios (MLRs) as a policy tool to ensure appropriate stewardship of managed care funds. The Federal MLR is the percentage of premium revenue that a managed care plan spent on covered health care services and quality improvement activities during a 12 month period. Federal MLR regulations allow States to require Medicaid managed care plans to meet a minimum MLR of at least 85 percent. States that set minimum MLRs with remittance requirements for their managed care plans could receive MLR remittance payments if plans fail to achieve at least the State-set minimum MLR. A minimum MLR with a remittance requirement limits financial risks for State and Federal governments. CMS is responsible for ensuring that States return to CMS the required Federal share of any MLR remittance payments that States receive from their plans. Our evaluation will determine whether and how CMS tracked that States returned to CMS the required Federal share of MLR remittances for the 2017-2018 and 2018-2019 MLR reporting periods.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
June 2024	Centers for Medicare and Medicaid Services	Medicaid Managed Care: CMS's Oversight of Whether States Return the Required Federal Share of Medical Loss Ratio Remittances	Office of Evaluation and Inspections	OEI-03-23-00041	2025