Announcement: SOA releases passing candidate numbers for October 2024 Exam FM.

Medicaid Managed Care Underwriting Margin Model

soa-research-societal-purpose-logo.png

July 2024

Authors:

Mardo Atoyan, MBA
Principal
HealthCare Analytics

Tom Donlon, FSA, MAAA, FCA
Managing Director
Legacy 3 Consulting

Grant Porter, PhD
Senior Consultant
Faulkner Consulting Group

Description

This report and the accompanying Excel model are intended to be used in their entirety by qualified actuaries setting rates or evaluating rates for Medicaid Managed Care programs to develop the underwriting margin component of the capitation rates. It should not be relied on for any other purpose. The methodologies and assumptions discussed in this paper as well as the calculations in the Excel model are not intended to account for all possible scenarios. Users should use actuarial judgment to determine if model results are appropriate for the specific circumstances of the program being evaluated. Actual underwriting margin results will vary from the model estimates.

Materials

Medicaid Managed Care Underwriting Margin Model

Underwriting Margin Model

Margin Model Data Backup

Previous Managed Care Underwriting Margin Models

2022 Medicaid Managed Care Underwriting Margin Model

Acknowledgments

We are thankful to the dedicated professionals from the Society of Actuaries Project Oversight Group (POG) who similarly recognize that establishing an adequate underwriting margin is paramount for maintaining the financial viability of the sector while being mindful of its potential implications for state and federal taxpayers. The final project benefited from the varied subject-matter expertise, general commentary and specific feedback provided by members of the POG including a member representing the Center for Medicare and Medicaid Services, an economist, a risk specialist, health plan actuaries, and state Medicaid capitation rate certifying actuaries.

The POG membership included the following persons:

Chair: Sabrina Gibson, FSA, MAAA
Bryan Bjork, FSA, MAAA
Tristan Cope, ASA
Elizabeth Gould, FSA, MAAA
George Mansour, MBA
Ian McCulla, FSA, MAAA
Jaredd Simons, ASA, MAAA
Mathew Stahl, ASA, MAAA, CERA
Steve Wander, FSA, MAAA, FCA
David Wierz

We are grateful to the SOA and its staff for bringing together the members of the POG and for sponsoring the project. Thank you to Achilles Natsis, FSA, MAAA, FLMI, for managing the project and keeping us accountable and Erika Schulty for administrative support throughout.

We also appreciate the generous support of the authors of the prior studies, including Sara Teppema and Jaredd Simons, who spoke with us on the last iteration of this project about their experience and findings from their respective studies in 2017 and 2019.

Questions or Comments?

Give us your feedback! Take a short survey on this report. Take Survey

If you have comments or questions, please send an email to research@soa.org.