Medical Loss Ratio Plan-to-State Reporting Template

This Excel reporting template supports states in improving their Medical Loss Ratio (MLR) data collection and validation processes from managed care plans (specified in 42 CFR 438.8(k)). It allows states to adapt it to their unique Medicaid managed care program needs. Various elements of the Excel template are customizable for state needs, including capturing data for specific eligibility groups, collecting net payments or receipts related to the state’s various risk sharing arrangements, SDPs, and targeted non-claims costs.

The template captures the requirements in 42 CFR 438.8(k) that states must comply with by providing tabs to collect detailed methodologies for allocation of expenditures and comparisons of the MLR information to the audited financial report.

The first step in implementing the Excel template is customizing it to state specifications based on the state’s Medicaid managed care contract and program requirements. This includes defining the MLR reporting period and runout date and customizing the MLR attestation language.

This template is additionally described in section VII of the MLR Monitoring, Reporting and Oversight: A Toolkit for States to Ensure Complete and Accurate MLR Reporting. Additional information and resources about MLR reporting and requirements can be found at https://www.medicaid.gov/medicaid/managed-care/guidance/medical-loss-ratio.