Description: According to the Actuarial Standards Board’s Actuarial Standard of Practice No. 49 (ASOP 49), actuarially sound Medicaid managed care capitation rates will include a provision for underwriting gain in order to provide compensation for the risks assumed by an MCO. However, there is no generally accepted method for quantifying underwriting gain in managed Medicaid capitation rates. This article discusses a new model developed to address this void and calculate underwriting gain. The model was developed by researching existing financial literature and performing a statistical analysis of industry data to build out a framework that can be leveraged to estimate underwriting gain.

Description: In Medicaid rate development, actuaries have not historically shared models that developed the margin (i.e., underwriting gain) assumption. This is unfortunate, given the margin assumption is one of the most critical components of the rate development in ensuring financial solvency of the Medicaid managed care organizations (MCOs). In this session, we will discuss the primary components of the this assumption and will share working models that help actuaries quantify these components—including the cost of capital and risk (or contingency) margin. We expect a lively discussion as we “open the black box” and discuss these actuarial assumptions in the public for the first time.