TX Strikes Out on MLR Waiver Request

Only 17 states and Guam filed MLR waiver requests for 2011 and CMS has acted on all but two: North Carolina and Wisconsin. Those decisions are expected by February 8 unless CMS extends the deadline by 30 days.

CMS has granted six waivers: Georgia, Iowa, Kentucky, Maine, New Hampshire, and Nevada. It denied a waiver for Guam and eight states: Delaware, Florida, Indiana, Kansas, Louisiana, Michigan, Oklahoma, North Dakota, and Texas.

Three states have appealed the denial of their MLR waiver requests. The appeals of Indiana, Louisiana, and most recently Florida were also denied. In a January 19 letter to Kevin McCarty, the Florida insurance commissioner, CMS's Steve Larsen said "we have found no basis to modify our previous determination."

Florida hinged its appeal efforts on three standard arguments:

1. The implementation of the new MLR requirement creates a barrier to entry
2. New MLR ratios would hurt the agent and broker workforce
3. Some insurers would potentially depart if the 80% MLR rate were upheld

In making the appeal McCarty contended that "failure to obtain the requested adjustment will cause permanent, irreparable harm to our market and the distribution channel for health products and services."

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