Medicaid Plans Aren’t Properly Reporting MLR Data, OIG Finds

Many of the medical loss ratio (MLR) reports that Medicaid managed care organizations submit to states are incomplete, and much of that missing data concerns how much MCOs are spending on administrative services, according to a new report from the HHS Office of Inspector General (OIG).

The report, published in September, is part of a “body of work” that the watchdog agency initiated a few years ago that focuses on the implementation of the federal MLR requirements for Medicaid managed care ushered in via the 2016 update to MCO regulations, the HHS-OIG Office of Evaluation and Inspections tells AIS Health via email. The new report builds upon a data brief issued in August 2021 that “served as a first-of-its-kind nationwide landscape of Medicaid managed care MLRs,” and found that most states established a minimum MLR of 85% for their contracted MCOs. That means plans must spend at least 85% of their premium revenue on covered health care services and quality improvement activities.

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