The managed care regulation requires that states develop valid managed care capitation rates in accordance with generally accepted actuarial principles and practices.
2024-2025 Medicaid Managed Care Rate Development Guide
CMS is releasing the 2024-2025 Medicaid Managed Care Rate Development Guide for states to use when setting rates with respect to any managed care program subject to federal actuarial soundness requirements during rating periods starting between July 1, 2024 and June 30, 2025. The guide provides detail around CMS' expectations of information to be included in actuarial rate certifications, and the guide will be used as a basis for CMS’ review. Please direct any questions related to this guide to MMCratesetting@cms.hhs.gov.
View previous years’ rate-setting guidance:
- 2023-2024 Medicaid Managed Care Rate Development Guide
- 2022-2023 Medicaid Managed Care Rate Development Guide
- 2021-2022 Medicaid Managed Care Rate Development Guide
- 2020-2021 Medicaid Managed Care Rate Development Guide
- 2019-2020 Medicaid Managed Care Rate Development Guide
- 2018-2019 Medicaid Managed Care Rate Development Guide
- 2017-2018 Medicaid Managed Care Rate Development Guide
- 2017 Managed Care Rate Setting Consultation Guide
- Addendum to 2016 Medicaid Managed Care Rate Development Guide
- 2016 Managed Care Rate Setting Consultation Guide
- 2015 Managed Care Rate Setting Consultation Guide
- 2014 Managed Care Rate Setting Consultation Guide