MedicaidAdministrativeLow impact
Provider Bulletin 03-28-2025 Medical Loss Ratio Requirements for Subcontractors and Downstream Subcontractors APL 24-018 IE LA SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California is implementing Medical Loss Ratio (MLR) reporting and remittance requirements for subcontractors and downstream subcontractors under their Medi-Cal contracts. Subcontractors receiving $30 million or more annually must report MLR data and may face remittance requirements if they don't meet the 85% MLR standard starting in 2025.
Action Required
For practices that are subcontractors or downstream subcontractors of Molina Healthcare receiving $30 million or more in Medi-Cal capitation annually: Review current MLR reporting capabilities and ensure ability to provide MLR data at agreement level broken down by county. Contact designated Molina Provider Relations Representative if practice meets materiality threshold to understand specific reporting requirements and deadlines.