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

January 20, 2013

HMOs participating in the Medicaid program are required to limit Medicaid and Medicare recipients to no more that 75 percent of enrollees and to draw at least 25 percent 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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