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.
Here are three things to know:
- According to the OIG, CMS’s financial reporting system does not contain dedicated data fields for MLR remittances. CMS staff do not routinely share information with each other about remittance amounts reported or returned, and they do not track when to expect payments from each state.
- The OIG issued several recommendations to CMS, including asking the agency to obtain the federal shares of MLR remittances from states that have not returned these amounts. OIG also recommended CMS develop the capacity to track what states owe the federal government from MLR remittances.
- CMS concurred with all of the OIG’s recommendations.
Read the full report here.
