Medicaid managed-care plans get federal regulations for state rates

October 01, 2014

The CMS issued guidance on the way states pay private health plans to oversee the care of Medicaid beneficiaries. The guidance outlines data requirements states must follow to show they are meeting the statutory requirement that payments to plans are actuarially sound. Of the more than 70 million people in Medicaid, 70% are in managed-care plans for at least part of their care, according to the CMS. The statute requires states to submit rates certified by a qualified actuary to the CMS. When states submit their rates in 2015 they will have to provide additional information that clearly illustrates how they arrived at the rates. States that expanded Medicaid under the ACA will also need to describe the data used to develop rates for the newly eligible groups.