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CMS is suspending new enrollment for a Centene Medicare Advantage subsidiary in Missouri after the company failed to meet the required medical loss ratio for three years in a row.
MA plans are required to spend at least 85% of the money they receive on patient care and quality improvement. If a company fails to meet that threshold for three consecutive years, CMS can stop the company from enrolling new beneficiaries. Wellcare of Missouri reported the following MLRs for its MAPD plan: 78.9% in 2021; 77.7% in 2022; and 84% in 2023.
Wellcare of Missouri will not be allowed to enroll new members in its Medicare Advantage prescription drug plan in 2025 and it will be removed as an option during the upcoming enrollment period, according to a Sept. 6 letter from CMS.
Wellcare must also ensure that all communications and marketing materials clearly state that it is not accepting new members in 2025. If the company reports an MLR of at least 85% in 2024, it may be allowed to enroll new members again in 2026. If not, the suspension will continue, and CMS could terminate the contract entirely.
Wellcare has until Sept. 17 to respond and until Sept. 23 to request an appeal.
[EXTERNAL LINK] - CMS suspends enrollment for Centene Medicare Advantage plan in Missouri
MA plans are required to spend at least 85% of the money they receive on patient care and quality improvement. If a company fails to meet that threshold for three consecutive years, CMS can stop the company from enrolling new beneficiaries. Wellcare of Missouri reported the following MLRs for its MAPD plan: 78.9% in 2021; 77.7% in 2022; and 84% in 2023.
Wellcare of Missouri will not be allowed to enroll new members in its Medicare Advantage prescription drug plan in 2025 and it will be removed as an option during the upcoming enrollment period, according to a Sept. 6 letter from CMS.
Wellcare must also ensure that all communications and marketing materials clearly state that it is not accepting new members in 2025. If the company reports an MLR of at least 85% in 2024, it may be allowed to enroll new members again in 2026. If not, the suspension will continue, and CMS could terminate the contract entirely.
Wellcare has until Sept. 17 to respond and until Sept. 23 to request an appeal.
[EXTERNAL LINK] - CMS suspends enrollment for Centene Medicare Advantage plan in Missouri
This is ONLY the start of your horrible karmic journey, ShitCare. This shitty MedicAID provider needs to go back where they belong.
