Medicaid Gains, Commercial Losses Continue in DHP Update

AIS Health’s data team on May 4 updated the Directory of Health Plans subscriber dashboard and in-app spreadsheets with new enrollment numbers. This data primarily reflects fourth-quarter 2020 status but includes first-quarter 2021 lives for Medicare Advantage products and some Medicaid figures, based on availability at the state level.

The team made two major ownership changes to reflect acquisitions that closed since the last update, including:

• Florida MHS, Inc. dba Magellan Complete Care is now reflected under the Molina Healthcare parent record after the acquisition closed in early 2021. We will continue to run the records separately until Magellan’s membership and business operations are fully consolidated under Molina.
• BlueCross BlueShield of Western New York and BlueShield of Northeastern New York is now reflected under the Highmark Health parent, after the acquisition closed in March 2021. The records will continue to be listed separately in DHP until business operations are fully consolidated under Highmark.

In addition, while Tufts Health Plan and Harvard Pilgrim Health Care finalized their deal to combine operations in January 2021, since they have not yet announced a new name and will continue to operate separately for now, DHP will continue to list them separately.

In the wake of the COVID-19 pandemic, Medicaid enrollment continues to steadily climb, increasing from last quarter by nearly 3 million members as states are better equipped to report new enrollments. Most significant jumps in this data release come from states that experience a greater lag time in their ability to report new enrollments, but we are continuing to see increases across the board in managed Medicaid. State Medicaid is still waning in some states, but this usually corresponds to a corresponding increase on the Medicaid HMO side.

Notable shifts in the Medicaid space include:

• Kentucky: Managed Medicaid plans jumped by 211,000 lives, an increase of 16% over the previous quarter. This coincides with a 122,000 decrease on the fee-for-service Medicaid side, part of an overall trend of states moving fee-for-service members to managed care plans. New entrant UnitedHealthcare gained 138,356 Medicaid members in Kentucky.
• Nebraska: The state saw its managed Medicaid membership jump by roughly 25,000 lives, while its fee-for-service membership also increased by more than 13,000 lives. Meanwhile, Anthem took over Centene Corp.’s WellCare contract in the state.
• Washington, D.C.: The District of Columbia state Medicaid record will be ended for the April update. Around 19,000 Medicaid adult beneficiaries transitioned from fee-for-service, and MCOs received a nearly equal number of enrollees through the reassignment process. Also of note in D.C.: MedStar Family Choice replaces Anthem, Inc.’s Amerigroup subsidiary as a contracted Medicaid MCO.

Commercial risk is still decreasing somewhat, dropping 725,000 lives since last quarter. Publicly traded insurers are continuing to report decreases on the administrative services only/self-funded side, but this is also leveling off. Other notable enrollment shifts since last quarter include an additional 1.4 million members enrolled in Medicare Advantage and nearly 250,000 newly enrolled Medicare-Medicaid dual-eligibles for the 2021 plan year.

AIS’s Directory of Health Plans, a unit of MMIT, maintains payer data and tracks enrollment of health insurers each quarter, as well as their PBM and specialty pharmacy contracts. Contact sales@AISHealth.com to have this access added to your account. Current subscribers can contact support@aishealth.com with questions about how to use or interpret the information provided to you in AIS’s Directory of Health Plans. A member of AIS Health’s support staff would be happy to provide a free demonstration of the website for clients needing more guidance on how to best use this tool.

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