Medicaid and CHIP now have over 90 million enrolled. According to the latest National Medicaid Managed Care Enrollment data (from 2020), 72% of Medicaid recipients were enrolled in a Comprehensive Managed Care Organization (MCO). In FY21, comprehensive Medicaid MCO payments accounted for 52% of total Medicaid spending, more than $376 billion.Medicaid is a major source of funding revenue and profit For insurance companies in multiple states. A KFF analysis of National Association of Insurance Commissioners (NAIC) data showed that gross profit per subscriber in the Medicaid managed care market was higher in 2021 than before the pandemic. Medicaid MCOs play an important role in the response to the COVID-19 pandemic, working with states to conduct outreach and provide support to enrollees during the “relaxation” of continuous coverage requirements is expected. Starting April 1, 2023, states will be able to resume deregistrations (which had been suspended since February 2020) after conducting a full eligibility review. Many will likely find themselves ineligible for Medicaid, and others may face administrative barriers and lose coverage despite remaining eligible. Medicaid MCOs have a financial interest in maintaining enrollment, which also prevents interruptions to enrollee care. This overview details the five largest publicly traded companies (also known as “parent” companies) that operate Medicaid MCOs, accounting for half of the nation’s Medicaid MCO registrants. The information and data reported in this overview are derived from quarterly company earnings reports, financial reports, other company documents and national government data.
Medicaid enrollees at the 5 largest publicly traded companies operating Medicaid MCOs
Five for-profit publicly traded companies—Centene, Elevance (formerly Anthem), UnitedHealth Group, Molina, and CVS Health—account for 50% of the nation’s Medicaid MCO registrations (Figure 1). All five companies are ranked in the Fortune 500 and four are ranked in the top 100, with total revenue reaching $32 billion (Molina) to $324 billion (united health groupEach company operates Medicaid MCOs in more than a dozen states (Figure 2). All five companies also operate in the commercial and Medicare markets (Figure 3). However, the distribution of members across the market varies from company to company. His two companies, Molina and Centene, have historically focused primarily on the Medicaid market. As of March 2023, Medicaid members make up more than 90% of his total medical membership in Molina and nearly 70% of his medical membership in Centene (Figure 3).
Combined, the five Medicaid subscribers increased by 13.5 million, or 44.1%, from March 2020 to March 2023 (Figure 4).. Overall Medicaid enrollment increased by more than 20 million (or approximately 31%) during the extended enrollment period (February 2020 to January 2023), resulting in an increase in MCO enrollments. Enrollment growth is primarily due to provisions of the Families First Coronavirus Response Act (FFCRA), which requires states to ensure continued enrollment of Medicaid enrollees in exchange for a temporary increase in Medicaid compliance. is. Growth in parent company Medicaid enrollment may also reflect other activity, such as business acquisitions and new contracts. For companies reporting this information, Medicaid revenue growth in 2022 was in the range of 11% compared to 2021 (Centene) to 18% (united health) to 21% (Molina). These same companies reported that Medicaid revenues increased in the 13% range of his (Centene) to 16% (united health) to 43% (Molina) YoY change in 2021 relative to 2020. Molina The Medicaid division reported medical benefits of $3 billion in 2022 and $2.3 billion in 2021 (Medical Margin = Premium Income – Medical Expenses).
The Impact of “Unwinding” on the Top 5 Publicly Traded Companies Operating Medicaid MCOs
All five companies expect Medicaid enrollments to decline after the end of continuous enrollment requirements (2023-2024). However, companies hope to retain some members who have lost Medicaid coverage in their marketplaces and other products (Appendix table). of Consolidated Appropriations Act 2023 The continuous coverage provision has ended, and states can resume withdrawals from April 1, 2023. The number of Medicaid participants who may be deenrolled during the deregistration period is highly uncertain, but it is estimated that millions will lose coverage. The KFF estimates that 17 million people could lose Medicaid coverage. This includes those who have lost their eligibility and those who are eligible but face administrative barriers to renewal. Medicaid coverage loss rates vary from state to state depending on how states approach mitigation. CMS is specific guidance Where appropriate, states will allow MCOs to update registrant contact information and conduct outreach on the recertification process to facilitate ongoing registration and marketplace transitions. Release CMS in June 2023 new guidance It highlights several new strategies states can use to prevent procedural terminations, such as allowing managed care plans to help registrants complete certain parts of renewal forms.
At the Q1 2023 investor call, executives from publicly traded companies operating Medicaid MCOs will support continued enrollment in Medicaid and migration to marketplaces (and other products) as needed In doing so, it has expressed the goal of maximizing the continuity of coverage for its members. These companies use direct communications, such as text messages, live calls, and community-based provider campaigns, to educate members about the Medicaid redetermination and renewal process, as well as marketplace options if they lose their Medicaid eligibility. and indirect outreach (Appendix table).
All five companies offer Qualified Health Plans (QHPs) in the ACA market in many states that operate Medicaid MCOs, but plans are inconsistent when they are operated locally There is a possibility. Current enrollees determined to be ineligible for Medicaid may apply to the ACA Marketplace (higher income eligibility criteria than Medicaid) or other coverage (e.g. Scope of CHIP or Employer Sponsored Insurance (ESI)). Zero premium plans may be available for individuals who qualify for coverage on the Marketplace. However, individuals who transition to marketplace coverage may face higher cost burdens and different providers her network.Pre-analysis suggestion Individuals face barriers in transitioning from Medicaid to other coverage programs, and many may experience coverage gaps. CMS guidance States may request MCOs, which also offer QHP, to share information with their registrants determined to be ineligible for Medicaid (unless state-specific laws and/or contractual requirements prohibit it), It outlines that it can be encouraged to help transition to marketplace adoption. this activity). To avoid gaps in coverage, managed care plans may contact individuals to proactively apply for marketplace coverage before they lose coverage.
for the future
Medicaid-administered care plans have the economic benefit of maintaining enrollment and can also prevent interruptions to enrollee care. The five publicly traded companies included in this analysis account for half of the nation’s Medicaid MCO enrollees. Many people are likely to lose their Medicaid eligibility if states lift their continuous coverage requirements. Some may face administrative barriers and lose coverage even though they remain eligible. Medicaid Managed Care Plans help state Medicaid agencies communicate with enrollees, provide outreach and support, and ultimately increase coverage, including facilitating marketplace transitions.
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