Oregon To Require Medicaid CCOs To Use Same Medical Loss Ratio For Expansion & Traditional Populations

For calendar year 2017, the Oregon Health Authority (OHA) is planning to require its Medicaid Coordinated Care Organizations (CCOs), which serve both the Medicaid expansion population and the traditional Medicaid population, to meet a minimum medical loss ratio (MLR) of at least 85%. Previously, Medicaid health plans were required to meet the 85% MLR benchmark for the Medicaid expansion population only as part of a provision of the Patient Protection and Affordable Care Act (PPACA). However, the PPACA did not require Medicaid health plans to meet a MLR for the traditional Medicaid population.

As a result, in 2014 11 CCOs . . .