ADA Calls for More Oversight and Transparency from Medicaid Managed Care Plans

February 28, 2023

In a new letter to the Centers for Medicare and Medicaid Services (CMS), representatives from the American Dental Association have asked for increased transparency regarding medical loss ratio (MLR) reporting from Medicaid managed care plans. The authors pointed out that many states were missing substantial chunks of MLR data in recent years.

According to Jennifer Garvin, “The letter noted that a brief from the Medicaid and CHIP Payment and Access Commission projected data from 2019 MLR requirements would be available in 2022. It also noted that a Health and Human Services’ Office of Inspector General September 2022 report reviewed 495 annual MLR reports from states to see if they contained the seven required data elements: claims costs; non-claims costs; quality-improvement expenses; premium revenue; taxes and fees; calculated MLR; and member months. It found that nearly half (49%) of the MLR reports submitted by managed care organizations in 28 states were incomplete and missing at least 1 of the 7 required data elements, thus allowing the reporting requirement to become optional.”

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