SFY 2021 - 2022 MC MLR Summary
Medicaid line of business
| SFY 2021 - 2022 MC MLR Summary | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Medicaid line of business | |||||||||
| Plan | MLR AFTER Credibility Adjustment |
Medical Expense (Total Numerator) |
Premium [Used for MLR%] (Total Denominator) |
Medicaid Only Premium [Used For Remittance] | Remittance | Credible | MMs | ||
| Affinity Health Plan, Inc. | 91.06% | $677,427,986 | $743,930,706 | $743,930,706 | $0 | Fully Credible | 1,681,821 | ||
| Anthem HP, LLC (HealthPlus) | 92.59% | $1,954,124,530 | $2,110,613,637 | $2,105,588,878 | $0 | Fully Credible | 4,429,591 | ||
| Capital District Physicians Health Plan, Inc (CDPHP) | 98.17% | $565,149,923 | $575,667,700 | $575,667,700 | $0 | Fully Credible | 1,250,950 | ||
| Excellus Health Plan, Inc. | 94.19% | $1,051,496,391 | $1,116,303,489 | $1,116,303,489 | $0 | Fully Credible | 2,607,979 | ||
| New York Quality Healthcare Corporation (Fidelis Care) | 87.66% | $8,347,925,500 | $9,523,385,606 | $9,472,110,594 | $0 | Fully Credible | 19,914,361 | ||
| Health Insurance Plan of Greater New York (Emblem) | 89.60% | $925,549,759 | $1,032,976,589 | $1,032,976,589 | $0 | Fully Credible | 1,889,394 | ||
| Healthfirst PHSP, Inc. | 92.01% | $7,054,438,337 | $7,666,964,620 | $7,666,964,620 | $0 | Fully Credible | 14,075,771 | ||
| Highmark Western and Northeastern New York Inc. (frmly Healthnow) | 94.05% | $310,977,738 | $330,646,131 | $330,646,131 | $0 | Fully Credible | 607,361 | ||
| Independent Health Association, Inc. | 92.77% | $344,381,873 | $371,216,244 | $371,216,244 | $0 | Fully Credible | 789,925 | ||
| MVP Health Plan, Inc. | 92.60% | $1,102,830,416 | $1,191,015,863 | $1,191,015,863 | $0 | Fully Credible | 2,380,400 | ||
| MetroPlus Health Plan, Inc. | 90.60% | $2,227,960,168 | $2,459,044,134 | $2,434,588,578 | $0 | Fully Credible | 5,437,214 | ||
| Molina Healthcare of New York, Inc. | 88.26% | $792,598,031 | $898,078,860 | $898,078,860 | $0 | Fully Credible | 2,025,290 | ||
| United Healthcare of New York, Inc. | 90.55% | $1,985,759,737 | $2,193,084,346 | $2,185,513,056 | $0 | Fully Credible | 4,744,196 | ||
| Total | $27,340,620,389 | $30,212,927,924 | $30,124,601,307 | $0 | 61,834,253 | ||||
NOTES:
Please note that the Remittance is for this line of business for one year ONLY based on a MLR Target of 86%.
The MLR% calculation for the Medicaid/Medicare integrated lines of business includes both the Medicare and Medicaid experience.
Remittances, if applicable, are calculated by multiplying the MLR% by the Medicaid Only Premium.
No remittance for plan if Non-Credible
