92% Of Medicaid Managed Care Plans Met Or Exceeded Federal Medical Loss Ratio Standard

Nationwide, 92% of the 513 Medicaid managed care plans—including managed care organization (MCO) plans, pre-paid inpatient health plans (PIHPs), and pre-paid ambulatory health plans (PAHPs)—achieved medical loss ratios that met or exceeded the federal medical loss ratio (MLR) target. The target is that 85% of premiums paid be used for direct member services.

Although federal MLR regulations do not require states to set minimum MLRs for their Medicaid managed care plans, 34 states did establish minimum MLRs for 434 plans. In these states, 91% of the plans met the state-set targets, and 9% (39 plans . . .