Frequently Asked Question (FAQ)

FAQ ID:  9260 Publish Date: 09/28/2018

Program Area:

Risk Adjustment (RA)

Primary Category:

Risk Adjustment Operations

Secondary Category:



How will Risk Adjustment (RA) payments and charges be transferred?


The Centers for Medicare & Medicaid Services (CMS) will collect funds from issuers due to remit charges and disburse collected funds to issuers receiving a payment. RA is a budget neutral program that transfers funds from plans with lower risk enrollees to plans with higher risk enrollees in a state market risk pool. Therefore, RA payments and charges within a market and risk pool must net to zero (0) dollars.


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