The Affordable Care Act allows the Secretary to adjust the 80% Medical Loss Ratio (MLR) standard for the individual market in a State. Between 2010 and 2017, adjustments were granted if it was determined that meeting the 80% MLR standard would destabilize the individual market. In order to qualify for this adjustment, a State had to demonstrate that requiring insurers in its individual market to meet the 80% MLR had a likelihood of destabilizing the individual market and would result in fewer choices for consumers. Beginning in 2018, the Secretary may adjust the individual market MLR standard in a State if the Secretary determines that there is a reasonable likelihood that an adjustment to the 80 percent MLR standard will help stabilize the individual market in that State.
The following HHS Bulletin describes the process for a State to submit a request for an adjustment to the MLR standard:
A State’s request for an adjustment to the MLR standard is a public document. To request a copy of a State's adjustment application, please email MLRAdjustments@cms.hhs.gov. Please include the name of the relevant State in the email subject line.
The Secretary invites public comment regarding a State’s request. To guarantee consideration, public comments must be submitted within 10 calendar days of HHS posting on this website, next to the State’s name, below, that the State’s application has been deemed complete. The public comment period is designed to give all interested parties full opportunity to present relevant information to the Secretary, which will be considered in making a timely determination on whether an adjustment to the statutory MLR standard is justified for the State applicant’s individual market. HHS is committed to providing accessible information to members of the public, including individuals with disabilities, and will provide an accessible copy of a State’s application to such individuals upon request, unless doing so would impose an undue burden on the agency. In order to ensure that individuals with disabilities have an equal opportunity to review a State’s application and submit comments, HHS may extend the public comment deadline for such individuals if necessary to account for any delay in providing an accessible copy of a State’s application.
To submit a comment regarding a State's adjustment application, please email MLRAdjustments@cms.hhs.gov. Please include the name of the relevant State in the email subject line.
This page contains State applications for an adjustment to the MLR standard for the individual market. When an application is deemed complete, the web page will be updated to reflect the deadline for public comment on the State’s application.
To request a copy of a State's adjustment application, please email MLRAdjustments@hhs.gov. Please include the name of the relevant State in the email subject line.
No State adjustment applications have been received to date.