SFY 2022 - 2023 MC MLR Summary
Medicaid line of business
| SFY 2022 - 2023 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 | ||
| Anthem HP, LLC (HealthPlus) | 91.31% | $2,215,309,848 | $2,426,268,615 | $2,389,581,435 | $0 | Fully Credible | 4,726,916 | ||
| Capital District Physicians Health Plan, Inc (CDPHP) | 96.26% | $617,733,265 | $641,755,467 | $641,755,467 | $0 | Fully Credible | 1,350,706 | ||
| Excellus Health Plan, Inc. | 91.18% | $1,108,142,925 | $1,215,287,515 | $1,215,287,515 | $0 | Fully Credible | 2,769,801 | ||
| New York Quality Healthcare Corporation (Fidelis Care) | 89.00% | $9,837,461,341 | $11,053,070,222 | $10,835,259,015 | $0 | Fully Credible | 21,033,004 | ||
| Health Insurance Plan of Greater New York (Emblem) | 93.48% | $1,051,930,405 | $1,125,351,666 | $1,125,351,666 | $0 | Fully Credible | 1,982,654 | ||
| Healthfirst PHSP, Inc. | 94.27% | $7,822,436,312 | $8,298,166,697 | $8,298,166,697 | $0 | Fully Credible | 14,912,334 | ||
| Highmark Western and Northeastern New York Inc. (frmly Healthnow) | 94.48% | $361,902,333 | $383,032,054 | $383,032,054 | $0 | Fully Credible | 677,775 | ||
| Independent Health Association, Inc. | 92.43% | $375,478,029 | $406,216,749 | $406,216,749 | $0 | Fully Credible | 838,312 | ||
| MVP Health Plan, Inc. | 93.27% | $1,205,186,783 | $1,292,176,261 | $1,292,176,261 | $0 | Fully Credible | 2,516,237 | ||
| MetroPlus Health Plan, Inc. | 89.26% | $2,591,401,596 | $2,903,291,860 | $2,854,845,386 | $0 | Fully Credible | 5,729,889 | ||
| Molina Healthcare of New York, Inc. | 85.76% | $1,501,250,940 | $1,750,559,441 | $1,750,559,441 | $4,201,343 | Fully Credible | 3,739,565 | ||
| United Healthcare of New York, Inc. | 89.16% | $1,943,631,209 | $2,179,991,762 | $2,130,854,651 | $0 | Fully Credible | 4,478,958 | ||
| Total | $30,631,864,986 | $33,675,168,307 | $33,323,086,336 | $4,201,343 | 64,756,151 | ||||
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
