The final Medicaid managed care rule released on April 25, 2016 provides a comprehensive modernization of Medicaid managed care rules and regulations. As a way of educating clients about the rule, Milliman is developing a series of papers that examine different implications for states, plans, and others.
Medical loss ratio (MLR) in the “Mega Reg”
While the Medicaid medical loss ratios (MLR) formula itself largely follows the commercial and Medicare Advantage (MA) MLR formula, there are key differences between the Medicaid minimum MLR standards and those currently established for the commercial and MA markets.
Institution for Mental Disease (IMD) as an "in lieu of" service
Federal monies for Medicaid services are generally not available to individuals between the ages of 21 and 64 living in an Institution for Mental Disease (IMD), but a combination of inpatient psychiatric capacity constraints and rapid enrollment growth in Medicaid may be leading to changes in state and Medicaid policies regarding the use of IMDs as an "in lieu of" service.