MLR Summary Reports
The MLR Summary Reports provide plan-specific MLRs for Medicaid managed care programs.
Freshness
- Last posted
- Period covered
- Update frequency
Dates as CMS lists them in its catalog.
Columns 14
| Column | What it means | Type |
|---|---|---|
Statestate | Name of the state/territory that submitted MLR data | string |
Program Nameprogram_name | Name of the program for which the state reported MLR data. | string |
Program Typeprogram_type | Category that best describes the program: Behavioral health only, Comprehensive MCO, Comprehensive MCO + MLTSS, Dental only, MLTSS only, Other PIHP, Other PAHP | string |
Eligibility Groupeligibility_group | Eligibility group category: All populations, Children, Group VIII expansion adults only, MH/SUD, MLTSS only, Non-expansion adult only, Other, Standalone CHIP | string |
If Other, Describe Eligibility Groupif_other_describe_eligibility_group | text | |
MCO, PIHP, or PAHP Namemco_pihp_or_pahp_name | text | |
MLR Reporting Period Start Datemlr_reporting_period_start_date | Start date of the MLR reporting period | date |
MLR Reporting Period End Datemlr_reporting_period_end_date | End date of the MLR reporting period | date |
Report Yearreport_year | Calendar year of the End date of the MLR reporting period | string |
MLR Numeratormlr_numerator | MLR numerator dollar value | string |
MLR Denominatormlr_denominator | MLR denominator dollar value | string |
State-Reported Member Monthsstatereported_member_months | text | |
Adjusted MLRadjusted_mlr | MLR percentage after any credibility adjustment is applied | string |
Remittance Dollar Amount for MLR Reporting Periodremittance_dollar_amount_for_mlr_reporting_period | Calculated remittance dollar amount owed by the plan for the MLR reporting period | string |
No column matches that filter.
At a glance
- Catalog
- data.medicaid.gov
- Publisher
- Centers for Medicare & Medicaid Services (CMS), data.medicaid.gov
- Rows
- 2,783
- Columns
- 14
- State column
state- Topics
- Medicaid and CHIP
- Contact
- Medicaid.gov@cms.hhs.gov
API
Free, no key needed. This request returns the first 10 rows as JSON:
https://data.medicaid.gov/api/1/datastore/query/743f9f04-4473-41e2-9da2-9a89db65ee55/0?limit=10
To keep only one state, filter on the state column.
CMS's description
The MLR Summary Reports provide plan-specific MLRs for Medicaid managed care programs. The MLR summary report data include MLRs for MCOs, PIHPs, and PAHPs submitted by states under 42 CFR § 438.74. Plan-specific data include: • Plan name • Reporting period start and end dates • Report Year • MLR numerator • MLR denominator • Member months • Adjusted MLR • Remittance amount owed by plan The report also provides: • State • Program name • Program type • Eligibility group (if applicable)
The summary at the top is the first sentence of this description. Record id mcd:743f9f04-4473-41e2-9da2-9a89db65ee55. This record as JSON.