Return of Medicaid Redeterminations Will Worsen Risk Pool, Actuaries Say

The return of Medicaid redeterminations and the resulting changes in the risk pool could mean a more expensive-to-cover mix of members for managed care organizations, according to a recent webinar convened by the American Academy of Actuaries. Experts say that Medicaid managed care organizations will likely lose healthy, employed members, but retain sicker members — and could face artificially inflated costs related to unnecessary disenrollments.

States can resume Medicaid eligibility redeterminations starting April 1, which means that private Medicaid health plans will see heavy turnover as all of their members are checked for eligibility by state Medicaid agencies. In exchange for a higher Federal Medical Assistance Percentage (FMAP) authorized by Congress as a pandemic relief measure, states agreed to stop income checks for the duration of the COVID-19 pandemic public health emergency (PHE).

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