Issues in Medicaid Managed Care Rate Setting

At the time of the May 2015 meeting, a new comprehensive draft regulation on Medicaid managed care was under review by the Obama Administration. This presentation provides an overview of Medicaid managed care payment rules currently in effect. It also raises possible issues in the forthcoming proposal that the Commission may wish to comment on once it is released, among them, minimum medical loss ratio, supplemental payments to Medicaid managed care organizations, transparency and mid-year changes in capitation rates, risk mitigation, and limitations of baseline and encounter data.