AIS’s Directory of Health Plans

Humana Inc. announced on Aug. 29 a value-based kidney care program with Evergreen Nephrology, which has nephrology practice partnerships in 17 states. Eligible Humana Medicare Advantage members with chronic or end-stage kidney disease will gain access to Evergreen professionals, who will collaborate with the members’ existing nephrologists. Todd DeYoung, associate vice president of Humana’s specialty and value-based partnerships, said in a press release that the program will “help improve both [members’] quality of care and quality of life.” Humana currently enrolls 1,132,350 MA and dual eligible members.

Elevance Health, Inc. will offer Affordable Care Act exchange plans in three new states next year. The insurer’s Wellpoint-branded plans will expand into Florida, Maryland and Texas — all states where it has a managed Medicaid presence. According to AIS’s Directory of Health Plans, Elevance Health has 1,074,000 members enrolled in ACA exchange plans, making it the insurer’s smallest market segment. As of 2024, the insurer offered exchange plans in 10 states, with California, Virginia and New York representing its three largest markets.

A federal judge has ruled that Tennessee wrongly removed thousands of individuals from its Medicaid program, TennCare, without proper notice or the opportunity for a fair hearing, according to an Aug. 27 report in Reuters. The initial lawsuit, brought in 2019, highlighted that the state failed to comply with federal redeterminations requirements, leading to many low-income residents losing their health care coverage while still eligible for Medicaid. The case now includes disenrollments from both before and after the COVID-19 pandemic. The ruling mandates that Tennessee must reinstate coverage for those affected and ensure compliance with federal Medicaid regulations moving forward. TennCare currently serves 484,544 beneficiaries via plans offered by BlueCross BlueShield of Tennessee, UnitedHealthcare and Elevance Health.

After a two-year stalemate, Mississippi has awarded managed care contracts for its Medicaid program, according to an Aug. 28 report in Mississippi Today, resolving a prolonged period of legal battles and political disputes. The contracts, valued at $3.8 billion each, were awarded to three companies: Centene Corp.’s Magnolia Health, UnitedHealthcare and Molina Healthcare. All are incumbents to the program. This decision is expected to enhance healthcare services for Medicaid recipients by improving care coordination and access to medical services. Managed care plans will link each enrollee with a regular source of primary care, provide access to a contracted network of providers, and offer support services such as care coordination and health education. The new contracts are expected to go live in May 2025. About 70% of Mississippi’s 696,356 Medicaid beneficiaries are currently enrolled in managed care.

L.A. Care Health Plan and Centene Corp.’s Health Net announced on Aug. 28 they have launched two programs that will collectively invest $90 million over five years to help people experiencing homelessness receive access to care. The health plans will invest $60 million in the L.A. County Field Medicine Program, in which 19 providers will provide coordinated care. They also will invest $30 million in the Skid Row Care Collaborative, which will include harm reduction services, extended hours for urgent care and pharmacies, and onsite specialty medical services in Los Angeles’s Skid Row neighborhood. The programs could assist about 85,000 Los Angeles residents, according to L.A. Care and Health Net. L.A. Care is the largest Medicaid insurer in California, serving 2,365,296 members, followed by Centene at 1,704,257 members.

CVS Health’s Aetna as of Sept. 1 now covers intrauterine insemination (IUI) as a medical benefit for its fully insured commercial products. Typically, IUI is only covered for members with a separate fertility benefit plan, either purchased by an individual or an employer group. "Expanding IUI coverage is yet another demonstration of Aetna's commitment to women's health across all communities, including LGBTQ+ and unpartnered people," Aetna’s Chief Medical Officer Cathy Moffitt said in a statement. "This industry-leading policy change is a stake in the ground, reflecting Aetna's support of all who need to use this benefit as a preliminary step in building their family." Aetna currently serves 4,735,003 members in commercial risk-based plans.

The Pennsylvania Department of Human Services last week announced the selection of applicants for the re-procurement of the Community HealthChoices program, which serves adults who are dually eligible for Medicare and Medicaid or require Medicaid long-term services and supports. The selected applicants, including Aetna Better Health of Pennsylvania, Health Partners Plans, Centene Corp.’s Pennsylvania Health and Wellness, UPMC For You, and AmeriHealth Caritas’ Vista Health Plan, will undergo a readiness review to ensure they meet all service requirements before contracts are officially awarded. This initiative aims to enhance the quality of life and freedom of choice for older Pennsylvanians and adults with disabilities. Pennsylvania’s managed Medicaid program currently serves 2,657,560 people.

Blue Cross and Blue Shield of Louisiana this month announced it will use a new name, Louisiana Blue, for marketing and promotions purposes. The company will continue to use BCBS of Louisiana as its formal name. It also introduced a new website URL and logo. Elevance Health, Inc. had agreed to acquire BCBS of Louisiana last year, but the deal fell through after state regulators brought up competitive concerns. The Blues insurer is the second-largest in the state, behind UnitedHealthcare, serving 1,098,912 members.

Good Measures and Point32Health have partnered to offer personalized nutrition support to members of Harvard Pilgrim Health Care, one of Point32Health’s two insurance subsidiaries. The initiative provides nutrition counseling, food tracking, and other services through the Good Measures app, targeting conditions such as diabetes, heart disease, and obesity. “Six of ten adults in the U.S. have a chronic disease, and poor nutrition and lack of physical activity are key lifestyle risks for chronic disease,” Raj Hazarika, vice president and commercial chief medical officer for Point32Health, said in a statement. The app will be available to all of Harvard Pilgrim’s fully insured group and individual commercial plan members. Eligibility for self-funded members will vary by employer and state. Point32Health currently serves 616,346 commercial risk-based members, with an additional 743,870 enrolled in self-funded products.

American Health Plans has partnered with Empath Health, a not-for-profit hospice and home-based health care organization, to grow its Institutional Special Needs Plan (I-SNP) presence. Based in Lakewood Ranch, Florida, Empath Health provides coordinated care for people with advanced, serious or terminal illnesses, with a special focus on vulnerable and frail patients in the community. Members of the American Health Advantage of Florida I-SNP will receive care that is supported by a team of nurse practitioners or physician assistants from TruHealth of Florida, the clinical arm of the I-SNP. With the implementation of American Health Advantage of Florida, American Health Plans will be operational in 13 states. The insurer currently serves 3,370 Medicare Advantage members.