Actuarial Soundness of Medicaid Managed Care Rates
The GAO has issued a report entitled “Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement,” which concludes that CMS has been inconsistent in reviewing states’ rate setting for compliance with the Medicaid managed care actuarial soundness requirements. Based in its review, the GAO recommends that CMS track state compliance with actuarial soundness requirements, clarify guidance on rate-setting reviews, and make use of information on data quality in overseeing states’ rate setting.
