Medicaid insurer told it must refund $12.3M

An insurer participating in the Arkansas Works Medicaid program was required to refund $12.3 million to the federal government, state and consumers after collecting too much in premiums compared with what it spent on claims, according to federal reports.

According to the reports by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services, St. Louis-based Centene collected $983 million in premiums for its plans covering Arkansas Works enrollees and other consumers in the state from 2016-18, but spent just $756 million of that on medical care and other health-related expenses.

The percentage of premiums that went to health care expenses -- 77% -- fell short of the 80% minimum percentage, known as the medical loss ratio, established by the 2010 Patient Protection and Affordable Care Act, triggering the required refunds.

According to the reports, Centene's plans covered 70,808 Arkansans as of March 31. Most of them are Medicaid recipients who have their premiums paid by the state Medicaid program under Arkansas Works. The company's plans are also available to consumers through the healthcare.gov website.

Read more: https://www.arkansasonline.com/news/2019/oct/27/medicaid-insurer-told-it-must-refund-12-1/?business