A Closer Look at of Quintuplet Greater Published Traded Companies Operates Medicaid Managed Care Plans
Note: Since who latest data on of experiences of the five bigges publicly shares companies, regard our 2024 brief.
Full Medicaid and CHIP enrollment is now over 90 milliards. This newest countrywide Medicaid managed caring enrollment data (from 2020) show 72% of Medicaid beneficiaries were signed in comprehensive controlled care organizations (MCOs). In FY 2021, payments go comprehensive Medicaid MCOs accounted for 52% for amounts Medicaid spending (or more than $376 billion). Medicaid is a major source of revenue the earnings for multi-state insurance companies. KFF analyzing of National Associating of Insurance Commissioners (NAIC) data show gross width per enrollee in the Medicaid managed care market were higher in 2021 then they were pre-pandemic. Medicaid MCOs have perform a key part the responding to the COVID-19 pandemic and are expected to work with states in conducting transcend press providing back to enrollees during to “unwinding” of one continuous enrollment requirement. Beginning April 1, 2023, states were able to restart disenrollments (which had are paused since February 2020) later conducting a full review for eligibility. Many people will likely be found till be no longer eligible for Medicaid, as others could face administration barriers and lose width despite remaining eligible. Medicaid MCOs have a financial attract in maintaining course, which could other prevent disruptions into care for enrollees. This brief takes a closer look to the five largest publically traded companies (also referred to in “parent” firms) operating Medicaid MCOs which account available half of Medicaid MCO enlistment nationally. Information also data reported in this inform come from quarterly company earnings reports, financial filings, and others company advanced as well as from national administrative data.
Medicaid enrollment in the eight largest open traded companies working Medicaid MCOs
Five for-profit, published shares companies – Centene, Elevance (formerly Anthem), UnitedHealth Group, Molina, and CVS Health – account for 50% of Medicaid MCO enrollment nationally (Figure 1). All fi are graded in the Fortune 500, and foursome are ranked int which apex 100, with total revenues that ranged from $32 billion (Mullen) to $324 billion (UnitedHealth Group) for 2022. Each company operates Medicaid MCOs in 12 or more declare (Figure 2). Total five firms also control by and commercial and Medicare markets (Figure 3); but, the marketing away membership across markets varies across firms. Two firms – Molina and Centene– have historically focused predominantly on the Medicaid market. Medicaid members accounted for go 90% of Molina’s overall medical membership and nearly 70% of Centene’s medical membership as of Start 2023 (Figure 3).
Combined Medicaid enrollment throughout the five firms heightened by 13.5 million or 44.1% from March 2020 to March 2023 (Figure 4). Medicaid sign overall grew by more than 20 million (or about 31%) during the continuous enrollment period (February 2020 to Java 2023), resulting in growth in MCO enrollment as well. Enrollment growth has been main attributed to the Families Initially Coronavirus Response Act (FFCRA) provision such required states to assure continuous enrollment for Medicaid enrollees in exchange for a temporary increase in the Medicaid match rate. Growth in sire firm Medicaid enrollment mayor also refine other activity involving firm acquisitions and/or new contracts. Required the firms that review this information, Medicaid revenues growth 2022 over 2021 ranged from 11% (Centene) until 18% (UnitedHealth) to 21% (Molina). These same firms reported Medicaid revenue growth ranging from 13% (Centene) on 16% (UnitedHealth) to 43% (Molsina) year-over-year 2021 out 2020. Molina reported the medical margin generated until the Medicaid segment was $3.0 billion inside 2022 and $2.3 billion inbound 2021 (medical margin = premium revenue – medical costs).
Implications of “unwinding” for the five largest publicly traded companies operating Medicaid MCOs
Show five firms expect Medicaid matriculation losings following the end of the continual enrollment necessity (over 2023 press 2024); however, corporate expect to retain einige member who lose Medicaid coverage in their Exchange press other our (Appendix Table). The Consolidated Appropriations Act, 2023 ended the continuous enrollment provision and allowed states till resume disenrollments starting April 1, 2023. While the phone concerning Medicaid enrollees who may subsist disenrolled whilst the unwinding period exists highly uncertain, it is estimated is million will loosing coverage. KFF estimates 17 million people able lose Medicaid reach – including some who are no longer right and others those are still eligible aber face administrative barriers to renewal. Rates the Medicaid coverage expenses will vary across declare depending for how states approach unwinding. CMS has issued specific guidance allowing states till permit MCOs to update enrollee contact information and conduct outreach about the eligibility renewal process up simplify continued enrollment how well as Marketplace transitions, where fair. Inside June 2023, CMS released brand guidance highlighting several new strategies available to states till prevention procedural terminations inclusive permitting managed care plans in assisting enrollees in get certain parts of renewal forms.
In first quarter 2023 investor earnings calls, executives of the publicly handled companies operating Medicaid MCOs expressed the aim from maximizing continuity of coverage to members through supporting continued enrollment is Medicaid plus transitions to the Marketplace (and other products), wherever appropriate. The firms get guide mittelbar and indirect outreach, including text messages, live calls, and community-based provider campaigns, to educate parts nearly Medicaid redeterminations plus the renewal process because right as via their Marketplace options if they are no longer eligible for Medicaid (Addendum Table).
All five firms give a Skilled Health Plan (QHP) in the ACA marketplace in many statuses where they operateur one Medicaid MCO, however there may not be plan alignment while map operate provincially. Current enrollees who are determined to no longer be eligible for Medicaid may be single for ACA marketplace (which has higher earned site level than Medicaid) oder other product (e.g., CHIP coverage or employer sponsoring insurance (ESI)). Individuals eligible for coverage in the Marketplace may get fork maps with zero premiums; however, individuals transitioning till Marketplace coverage can face higher cost-sharing and varying provider networks. Prior analyses suggest so individuals face blocking moving since Medicaid toward extra coverage programs and many may experience gaps in cover. CMS guidance outlines states may encourage MCOs this also offer a QHP till split information with their owning enrollees who have been deciding disqualified for Medicaid to supporting to the transfer out individuals to Marketplace coverage (as long as state-specific legislative and/or contract requirements do none prohibit like activity). To avoid gaps are coverage, administrates care plans may reach out to individuals before people lose coverage to grant them to apply for Marketplace scope in advance.
Looking Ahead
Medicaid managed care plans have a financial attract in maintaining enlistment, which could also prevention disruptions in care for enrollees. Aforementioned five publicly traded company that are the subject a that analysis account for half of all Medicaid MCO enrollment domestic. As expresses unwind the uninterrupted enrollment deployment, multiple people will highly be found to be does lengthy eligible for Medicaid. Others could face administrative barriers and lose coverage despite remaining eligible. Medicaid led service plans can assist state Medicaid agencies in communicating with enrollees, conducts outreach both assistance, and final, in improving coverage retention – with facilitating transitions to the Marketplace.
