Now in its 18th annual edition, this Milliman research report provides comprehensive benchmarking data on the financial performance of Medicaid managed care organizations (MCOs) across the United States. Drawing on statutory NAIC annual statement filings, the report analyzes CY 2025 results for 186 MCOs across 38 states, the District of Columbia, and the Commonwealth of Puerto Rico, representing $305.1 billion in Medicaid revenue. Key metrics include the medical loss ratio (MLR), administrative loss ratio (ALR), underwriting (UW) ratio, and risk-based capital (RBC) ratio, stratified by CMS region, revenue size, MCO type, financial structure, and Medicaid expansion status.

What were some of the CY2025 financial results, in brief?

The CY 2025 results reflect a market still adjusting to the post-pandemic enrollment landscape. The composite UW ratio was (0.1%) in CY 2025 — a slight improvement from the (0.6%) loss reported in CY 2024, but a material departure from the 2.5%–3.5% underwriting gains recorded from CY 2021 through CY 2023, and above the pre-COVID range of 0.3%–0.9%. Roughly half of MCOs in the analysis reported underwriting losses for the year, though the distribution of results converged meaningfully relative to CY 2024. The composite CMS MLR declined slightly to 94.3%, RBC ratios decreased to 429% from 452% in the prior year, and the ALR fell below 10% for the first time in several years.

On the administrative cost side, PMPM expenses increased for the second consecutive year — consistent with fixed costs spreading over smaller enrolled populations following PHE unwinding disenrollments — while the ALR net of taxes and fees held relatively stable, suggesting that revenue growth has outpaced administrative cost increases on a ratio basis. For state Medicaid directors and MCO executives monitoring rate adequacy, solvency, and administrative efficiency heading into CY 2026, this report provides the national and state-level benchmarks needed to contextualize plan-specific performance.