Medical Loss Ratio

Maine Request for an Adjustment of the Medical Loss Ratio Standard

The Affordable Care Act allows the Secretary to adjust the Medical Loss Ratio (MLR) standard for a state for up to three years if it is determined that meeting the 80 percent Medical Loss Ratio standard may destabilize the individual market. In order to qualify for this adjustment, a state must demonstrate that requiring insurers in its individual market to meet the 80 percent MLR has a likelihood of destabilizing the individual market and could result in fewer choices for consumers. This page contains materials related to this state’s application for an adjustment to the MLR standard for the individual market.

State: Maine

Application Status: 2011 HHS determination issued; 2013 request for continuation submitted  

Application Determination:

• HHS Determination on Maine MLR Adjustment Request (PDF) (PDF – 411 KB)
• Fact Sheet (Posted on 3/8/11)

Application Materials:

1. MLR Adjustment Continuation Request (PDF) (PDF - 117 KB)
   This document is Maine's request for continuation of the adjustment of the MLR standard to 65 percent for 2013 (received by HHS on 07/18/12).
2. MLR Adjustment Continuation Request Status Inquiry (PDF) (PDF - 82 KB)
   This document is Maine's inquiry regarding the status of its request for continuation of the adjustment of the MLR standard to 65 percent for 2013 (received by HHS on 11/20/12).
3. HHS Letter Responding to Maine's Request (PDF) (PDF - 74 KB)
   This document is a January 9, 2013 letter from the Acting Director of the Oversight Group to Maine responding to Maine's request for continuation of the adjustment of the MLR standard for 2013.

Additional materials, including all information submitted by the State, correspondence from HHS, and any public comments, are available upon request.  Please email MLRQuestions@cms.hhs.gov.