Currently, under the Patient Protection and Affordable Care Act, all health insurers must meet a medical loss ratio requirement, which is the amount of total revenue an insurer must spend on patient care and quality improvement as opposed to administrative costs and profits.
Health insurers in large group markets must meet the MLR standard of 85 percent, while small group and individual market insurers must have an MLR of 80 percent.
The MLR requirements do not apply to Medicaid, but some states have imposed MLR requirements on Medicaid managed care organizations. Here are the 10 states that have MLR requirements for Medicaid MCOs, with the MLRs in parenthesis.
• Arizona (84 percent)
• Hawaii (91.5 percent or 93 percent, depending on the plan)
• Illinois (80 percent)
• Indiana (85 percent)
• Maryland (85 percent)
• New Jersey (80 percent)
• New Mexico (85 percent)
• Ohio (85 percent)
• Virginia (92 percent)
• Washington (80 percent)
(Note: The District of Columbia has an 85 percent MLR requirement for its Medicaid MCOs.)
Health insurers in large group markets must meet the MLR standard of 85 percent, while small group and individual market insurers must have an MLR of 80 percent.
The MLR requirements do not apply to Medicaid, but some states have imposed MLR requirements on Medicaid managed care organizations. Here are the 10 states that have MLR requirements for Medicaid MCOs, with the MLRs in parenthesis.
• Arizona (84 percent)
• Hawaii (91.5 percent or 93 percent, depending on the plan)
• Illinois (80 percent)
• Indiana (85 percent)
• Maryland (85 percent)
• New Jersey (80 percent)
• New Mexico (85 percent)
• Ohio (85 percent)
• Virginia (92 percent)
• Washington (80 percent)
(Note: The District of Columbia has an 85 percent MLR requirement for its Medicaid MCOs.)
More Articles on Medical Loss Ratios:
HHS Ramps Up Medical Loss Ratio Efforts
Healthcare Reform: Two Years Gone, Now What's on the Horizon?
HHS Rejects Texas' Request for Medical Loss Ratio Waiver