I write on behalf of the Association for Community Affiliated Plans (ACAP) to follow up on our April 29, 2014 letter to you regarding the expected update to the Medicaid Managed Care regulations (42 CFR Part 438). While we did not include comments on the medical loss ratio (MLR) in our original letter, it has come to our attention that CMCS is considering including MLR requirements in the proposed update, and we wanted to share several perspectives with you and your staff.
We believe there are several issues you may want to consider as you evaluate the feasibility and appropriateness of a nationwide minimum Medicaid MLR and its impact on nonprofit Safety Net Health Plans (SNHP) and their ability to continue to provide needed services to their enrollees. For your convenience, we have categorized the recommendations into three areas:
Provisions to recognize the uniqueness of the Medicaid program and Safety Net Health Plans
Provisions related to medical and quality expenses