Medicaid Managed Care Underwriting Margin Model

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 research project offers guidance and a model for actuaries to use when performing their professional services related to Medicaid (Title XIX) and Children’s Health Insurance Program (CHIP or Title XXI) managed care capitation rate setting, including, but not limited to, their certification on behalf of a state in accordance with the requirements for actuarial soundness as set forth in law, federal regulation, and CMS guidance, as well as the actuary’s professional obligations under the Actuarial Standard of Practice (ASOP) 49 issued by the Actuarial Standards Board. The authors intend for this model to be used in the development of comprehensive medical rates for MMC. Additional considerations may be necessary in its application to limited benefit plans, such as dental-only products, or for Medicare/Medicaid product lines, such as Dual eligible special needs plans (D-SNP).

Materials

Medicaid Managed Care Underwriting Margin Model

SOA 2022 Underwriting Margin Model

SOA 2022 Underwriting Margin Model Data Backup

Podcast

Research Insights - Medicaid Managed Care Underwriting Margin Model

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