AIS’s Directory of Health Plans

Minnesota’s state legislature last week passed legislation that will establish public option health insurance in the state by 2027, joining Colorado, Washington and Nevada in similar efforts. Next year, the state will conduct an actuarial analysis on the initiative, which would serve as an expansion of MinnesotaCare, a state health plan for people living below 200% of the federal poverty line. Payer groups such as AHIP and Minnesota-based health systems have rallied against the proposal. The three largest payers in Minnesota are Blue Cross and Blue Shield of Minnesota (2,166,301 members), the provider-sponsored insurer HealthPartners (903,759 members) and nonprofit insurer Medica (663,434 members).

Boston-based health system Tufts Medicine has joined Blue Cross Blue Shield of Massachusetts’ pay-for-equity financial payment model that launched earlier this year, according to a May 23 press release. The arrangement, the first of its kind in Massachusetts, seeks to address health inequities and decrease racial gaps in health care. The Blues insurer said with the addition of Tufts, 53% of its members are now receiving care from providers within the initiative. Blue Cross Blue Shield of Massachusetts is the largest insurer in its home state, serving 2,229,079 members. About 38% of its members are enrolled in commercial risk-based products, with an additional 58% served via self-funded arrangements with employer groups.

Oscar Health will exit the California Affordable Care Act exchange market, Covered California, for the 2024 plan year, executives revealed during the insurance startup’s first-quarter 2023 earnings call. The California exit is part of a push toward profitability, as the plan “has not met our targets,” CEO Mark Bertolini said during the call. Oscar is currently the seventh-largest exchange insurer in the state, serving 44,658 members. Oscar is the fourth-largest exchange insurer nationally, with 977,408 members.

Sentara Healthcare, a Norfolk, Va.-based nonprofit health systems of 14 hospitals that also operates a health insurer, said it will combine its Medicaid products into a single plan. The two plans, Virginia Premier and Optima Health, will be united under the Optima Health name beginning July 1. “[This] will enable us to continue to provide a superior customer experience for our Medicaid membership — while also creating efficiencies that support lower costs for the state and reduced administrative burden on health care providers, Colin Drozdowski, president of Sentara Health Plans, said in a May 10 press release. Virginia Premier’s dual eligible Special Needs Plan will continue to operate as Virginia Premier. Virginia Premier currently enrolls 318,705 Medicaid and CHIP members to Optima Health’s 314,982. Sentara is the largest managed Medicaid insurer in Virginia.

Humana Inc. is partnering with Longevity Health, a clinical services company and national Institutional Special Needs (I-SNP) plan, on new I-SNP offerings in Georgia and South Carolina. These SNPs are “designed to materially improve health outcomes through holistic, patient-centric care plans,” according to a May 4 press release. Following the initial launch, the partnership with expand to five more states in 2024, with more geographies to come in 2025. Plan benefits will include onsite clinicians dedicated to comprehensive care management, $0 copays for primary care and behavioral health visits, transportation to medical appointments and hearing aid coverage. Longevity currently enrolls 4,768 members in its I-SNP plans in seven states. Humana, meanwhile, enrolls 829,093 members in Special Needs Plans nationwide.

House Republicans on April 26 passed debt-ceiling legislation that reintroduced Medicaid work requirements — a controversial Medicaid reform that was adopted by several states during the Trump administration — at the federal level. A new analysis from KFF, meanwhile, predicts that House Republicans’ Medicaid work requirements proposal would leave 1.7 million enrollees ineligible for Medicaid. Under the proposal, states could continue to cover enrollees who violate the work requirement, but they would have to cover 100% of their costs without federal help, which could ultimately shift $10.3 billion in spending to state governments, KFF projected. As of April 2023, 95.6 million people currently receive Medicaid benefits, a 29.6% increase from the outset of the COVID-19 pandemic in March 2020.

CareSource, an Ohio-based nonprofit health insurer with a significant Medicaid presence, will invest $1 million in Augment Therapy. Augment is a “digital health company enhancing rehabilitative health care and exercise through immersive and gamified technology,” according to a May 2 press release. CareSource, which holds Medicaid contracts in four states, has announced several deals in recent months, including an agreement with Walmart Inc. to enhance pregnancy and postnatal care for CareSource members, and a tech-oriented deal with Michigan-based nonprofit insurer Health Alliance Plan. The insurer currently enrolls 2,389,072 lives.

Centene Corp. last week said it will sell Apixio, its value-based care and artificial intelligence (AI) platform, to private equity firm New Mountain Capital for an undisclosed sum. The company, which originally acquired Apixio in 2015, said that the transaction will be neutral for 2023 earnings. This is the latest in a series of divestments and spinoffs orchestrated by Centene’s senior leadership, who are in the process of refocusing on Centene’s core health benefits businesses. The insurer sold pharmacy subsidiaries PANTHERx and Magellan Rx last year. Centene is currently the fourth-largest insurer nationally, with 21,669,643 medical lives.

Georgia Gov. Brian Kemp (R) last week signed into law a bill that establishes a state-run Affordable Care Act exchange, moving the state away from the federal marketplace. CMS must still approve of the transition, which would begin this fall for coverage beginning in January 2024. The three largest exchange insurers in Georgia are Centene Corp. with 325,239 members, Elevance Health with about 70,000 members, and Oscar Health with about 70,000 members.

Blue Cross Blue Shield of Michigan and Blue Cross and Blue Shield of Vermont on May 1 unveiled plans for an affiliation deal that “will enable the organizations to broaden the range of health plan and service solutions that will further benefit members and customer groups, while remaining within and committed to local communities in both states,” per a press release from the insurers. The deal, which will place the Vermont Blues payer under Blue Cross Blue Shield of Michigan’s enterprise umbrella, is cashless, with the two insurers maintaining separate legal entities, leadership and headquarters. Blue Cross Blue Shield of Michigan is the largest insurer in its home state, serving 4,504,098 members, as is Blue Cross and Blue Shield of Vermont, with 163,952 members.