This amendment reflects additional revenue to the Virginia Health Care Fund of $127.3 million the first year and $149.6 million the second year from managed care organization (MCO) repayments resulting from not meeting the medical loss ratio (MLR) requirement or for exceeding the profit caps that apply to Medicaid MCOs. The impact of the COVID-19 pandemic on health care utilization has resulted in increased profits and difficulty in meeting the MLR requirement for MCOs and therefore results in repayments to the Commonwealth. These repayments are deposited in the Health Care Fund, which is used as state match for Medicaid. Therefore, the increase in revenue results in a corresponding reduction in general fund appropriation for Medicaid.