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Seventy-five/twenty-five (75/25) Rule

Compliance • January 20, 2013 at 6:00 PM • Written by: PeopleKeep Team

Health maintenance organizations (HMOs) participating in the Medicaid program are required to limit Medicaid and Medicare recipients to no more than 75% of enrollees and to draw at least 25% of their enrollees from the private sector. This "75/25" is imposed to ensure that care provided to Medicaid enrollees is comparable to that provided to enrollees with private insurance.

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