Becker's Healthcare May 20, 2025
CMS cannot track whether states are repaying the federal government the correct share of funds Medicaid managed care plans do not spend on beneficiary care, according to an audit HHS Office of Inspector General published May 16.
Many states require Medicaid managed care plans to reach a minimum medical loss ratio — spending a certain percentage of money on enrollees’ healthcare. When plans do not meet these minimum thresholds, states can require plans to refund the unspent money as MLR remittances.
Medicaid managed care plans must pay some of these funds to the federal government, but the OIG found CMS cannot track if states return these required shares to the federal government.
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