Medicaid Underwriting Margin Update
Background
Significant guidance for Medicaid rate setting methodology exists through Actuarial Standards of Practice and the CMS final rate rule and annual updates. These references focus mainly on claims and administrative costs but offer very little guidance on underwriting margin methodologies. The Society of Actuaries (SOA) Research Institute has recently published a report and excel tool to help guide actuaries on appropriate methodologies and values for the Medicaid underwriting margin assumptions.
Research Objective and Deliverables
This project would update the Medicaid underwriting model and report to reflect emerging factors that materially impact financial results and Medicaid Managed Care Organization (MCO) risks and incorporate additional up-to-date rate setting and MCO financial data, as well as any new insights within the accompanying report.
Target Audience and Impact
Health actuaries who work with Medicaid Managed Care will have up-to-date information and tools to guide their development of Medicaid underwriting margin assumptions.
Estimated Cost
$75,000
Estimated Timeline
Approximately 6–9 months