SFY 2022 - 2023 MC MLR Summary
MAP line of business
| SFY 2022 - 2023 MC MLR Summary | ||||||||
|---|---|---|---|---|---|---|---|---|
| MAP 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 | |
| AgeWell New York, LLC MAP | 117.40% | $9,492,440 | $8,085,459 | $5,318,845 | $0 | Non-Credible | 1,088 | |
| Anthem HP, LLC (HealthPlus) | 97.52% | $13,907,422 | $14,260,669 | $10,061,820 | $0 | Non-Credible | 1,855 | |
| Centers Plan for Healthy Living, LLC | 90.23% | $91,278,787 | $107,410,744 | $75,576,448 | $0 | Partially Credible | 15,209 | |
| Elderplan, Inc. d/b/a Homefirst | 87.14% | $232,171,400 | $277,286,632 | $188,859,608 | $0 | Partially Credible | 36,808 | |
| Elderserve MAP dba Riverspring | 101.45% | $12,371,941 | $12,195,379 | $8,952,297 | $0 | Non-Credible | 1,607 | |
| New York Quality Healthcare Corporation (Fidelis Care) | 119.58% | $44,535,991 | $39,934,877 | $28,873,452 | $0 | Partially Credible | 6,240 | |
| Hamaspik, Inc. | 96.42% | $35,026,778 | $39,774,637 | $27,054,911 | $0 | Partially Credible | 5,512 | |
| Healthfirst Healthplan, Inc. | 91.55% | $1,769,661,578 | $1,960,313,951 | $1,303,940,918 | $0 | Partially Credible | 274,978 | |
| MetroPlus Health Plan, Inc. | 90.87% | $2,636,638 | $2,901,485 | $1,842,449 | $0 | Non-Credible | 393 | |
| Senior Whole Health of New York, Inc. | 90.07% | $13,224,607 | $14,683,059 | $10,955,056 | $0 | Non-Credible | 1,635 | |
| Village Senior Services Corp. (VillageCare Max) | 94.59% | $195,730,999 | $215,177,219 | $153,927,943 | $0 | Partially Credible | 32,165 | |
| VNS (d/b/a VNSNY Choice) and Subsidiary | 90.15% | $302,084,645 | $348,212,120 | $224,794,345 | $0 | Partially Credible | 37,111 | |
| Total | $2,722,123,226 | $3,040,236,231 | $2,040,158,091 | $0 | 414,601 | |||
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
