The CMS has sent a final rule to overhaul the managed Medicaid program to the Office of Management and Budget. The OMB review can take up to 90 days, which means the final rule could be published by May.
The 653-page proposal suggested the biggest changes in Medicaid managed-care regulations in more than a decade. It would cap insurer profits, require states to more rigorously supervise the adequacy of plans' provider networks and encourage states to establish quality rating systems for health plans.
Jeff Myers of Medicaid Health Plans of America said he hoped the CMS had removed language establishing a federal minimum medical-loss ratio of 85%. Joe Moser, Indiana's Medicaid director, said last fall he had hoped the CMS would drop the rule in its entirety. “It's the federal government dictating to states how they should run their programs,” Moser said.
Thirty-nine states and the District of Columbia outsource their Medicaid programs by paying fixed monthly sums to private managed-care plans, which last year yielded $115 billion in revenue for insurers, and $2.4 billion in operating profits, according to data analyzed by Kaiser Health News.
About 46 million people, or 73% of all regular Medicaid beneficiaries, are in managed-care plans. That figure will rise through Medicaid expansion to low-income adults, according to healthcare consulting firm Avalere Health.