Health insurers in large group markets must meet the MLR standard of 85 percent, while small group and individual market insurers must have an MLR of 80 percent.
The MLR requirements do not apply to Medicaid, but some states have imposed MLR requirements on Medicaid managed care organizations. Here are the 10 states that have MLR requirements for Medicaid MCOs, with the MLRs in parenthesis.
• Arizona (84 percent)
• Hawaii (91.5 percent or 93 percent, depending on the plan)
• Illinois (80 percent)
• Indiana (85 percent)
• Maryland (85 percent)
• New Jersey (80 percent)
• New Mexico (85 percent)
• Ohio (85 percent)
• Virginia (92 percent)
• Washington (80 percent)
(Note: The District of Columbia has an 85 percent MLR requirement for its Medicaid MCOs.)
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