Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Payments
Program Area: Risk Adjustment (RA)
Question: How do state payment transfers in the Risk Adjustment (RA) program state transfer funds between metal levels?
Answer: RA state payment transfers are calculated for all plans in a risk pool in a state market. There are three risk pools in all HHS-operated states except Vermont and Massachusetts: 1) individual market and all metal (platinum, gold, silver, bronze) plans; 2) individual market and all catastrophic plans, and 3) small group market and all metal plans. Please note that for Vermont and Massachusetts there are two risk pools because these two (2) states have merged their individual and small group markets for all metal plans: 1) individual and small group markets and all metal plans and 2) individual market and all catastrophic plans. Please note that for Vermont and Massachusetts there are two risk pools because these two (2) states have merged their individual and small group markets for all metal plans: 1) individual and small group markets and all metal plans and 2) individual market and all catastrophic plans.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 28, 2018
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