Personalized Employee Benefits Resources | PeopleKeep

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

Written by PeopleKeep Team | January 21, 2013 at 1:00 AM

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.