Good Afternoon Everyone:
I wanted to make sure that you saw the Alliance Daily article about the MLR Analysis we performed on Medicaid MLTSS plans. As you may know, MLR is a calculation used to measure revenue received by a health plan that was used to pay for services and for quality improvement activities. Medicaid law and statute do not require states to establish a mandatory minimum MLR for managed care organizations; however, guidance on setting the payment rates (i.e. "capitation" amounts) directs actuaries to target no less than 85%, provided that the rates account for reasonable non-benefit related costs. A few weeks ago, CMS released data that includes MLR information from plan years 2018, 2019, and 2020.
The Alliance analyzed the MLR information to better understand health plan payment policy around the country. As part of the analysis, the Alliance filtered data to include only those plans that include long-term services and supports (LTSS), as these are the services most important to our members. Overall, the national average MLRs for managed LTSS plans (MLTSS) were 93.70% in 2018; 93.54% in 2019 and 91.85% in 2020.
The full report is available online at: https://nahc.org/wp-content/uploads/2024/11/MLR-MLTSS-Analysis.pdf
Please let me know if you have any questions or would like us to do additional analysis on the MLRs.
Thanks!
Damon
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Damon Terzaghi
Director of Medicaid Advocacy
National Alliance for Care at Home
Washington DC
+1 (202) 547-7424
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