AIS’s Directory of Health Plans

Centene Corp. executives told investors during the company’s fourth-quarter 2022 earnings call that they expect to lose 2.2 million Medicaid members over the next 18 months as Medicaid redeterminations resume. CEO Sarah London said she expects 200,000 to 300,000 of those members to enroll in the insurer’s Affordable Care Act exchange products. Centene is currently the largest managed Medicaid insurer in the U.S., with 14,771,751 members across 28 states.

With the COVID-19 Public Health Emergency set to end on May 11, the Biden administration on Jan. 27 unveiled plans for a special enrollment period (SEP) on the Affordable Care Act marketplace for people losing Medicaid and CHIP coverage. The SEP will run between March 31, 2023, and July 31, 2024. Enrollees will have to “attest to a last date of Medicaid or CHIP coverage within the same time period,” although documentation of the coverage loss will not be required. 14,603,402 people are currently enrolled in exchange plans, according to the latest update to AIS’s Directory of Health Plans.

New Mexico last week canceled its managed Medicaid procurement process, citing recent leadership changes in its Human Services Department. The state was preparing to relaunch its current Centennial Care program as Turquoise Care, which would integrate physical health, behavioral health and long-term care services, while emphasizing social determinants of health, in 2024. Centennial Care is currently served by Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, and Centene Corp.’s Western Sky Community Care, with Presbyterian leading the pack at 426,769 beneficiaries. Of New Mexico’s 885,048 full-risk Medicaid beneficiaries, 92.0% are enrolled in a managed care plan.

Blue Shield of California this week said it is launching a virtual-first health plan for employer groups, Virtual Blue. Benefits will include $0 virtual primary care visits, as well as integrated behavioral health services and access to specialty care in 20 specialties. Coverage will begin April 1. Blue Shield of California is the third-largest insurer in its home state’s group risk-based market, with 1,415,281 members. Kaiser Foundation Health Plan, Inc. and Elevance Health hold the top two spots.

Philadelphia-based Blues affiliate Independence Blue Cross on Jan. 26 said it will launch an Advanced Network for Gene-Based Therapeutics in March of this year. The insurer is partnering with Penn Medicine and Children’s Hospital of Philadelphia in the creation of the new network, noting both providers “have played pivotal roles in the development and clinical trials of first-in-the-nation gene-based therapies.” While the network is intended to help Independence members access gene therapies, the press release noted that Luxturna and Zynteglo, both covered under Independence’s medical benefit, will “continue to require precertification.” Independence is currently the second-largest insurer in Pennsylvania, with 1,993,695 members.

National Blues powerhouse Elevance Health has entered an agreement to acquire Blue Cross and Blue Shield of Louisiana, a move that would unite the two payers under Elevance’s Anthem branding. The two orgs are already joint owners of Healthy Blue, a Louisiana Medicaid plan. BCBSLA’s 1,049,170 members would expand Elevance’s presence in the state by 281%. Financial terms of the deal, which Elevance expects to close later this year, were not disclosed.

The state of Georgia has no plans to implement a full Medicaid expansion, according to a Jan. 20 report in the Atlanta Journal-Constitution. The state’s newly elected House Speaker, Jon Burns (R), told reporters lawmakers will instead work toward installing Gov. Brian Kemp (R)’s partial expansion plan, a waiver program that would allow low-income adults to enroll in Medicaid if they meet a work requirement. The Trump administration approved the program, Georgia Pathways to Coverage, in October 2020, and the state hopes to begin implementation by this summer. Georgia currently serves 2,799,066 Medicaid beneficiaries, with 76.7% enrolled in managed care plans. The state estimates about 50,000 additional lives would enroll under Pathways to Coverage.

Norfolk, Virginia-based health system Sentara Healthcare has finalized its purchase of nonprofit health insurer AvMed. The deal will expand Sentara’s presence to Florida, where Miami-based AvMed currently serves 230,785 medical lives in its commercial health insurance products. Sentara’s health insurance subsidiaries, Optima Health and Virginia Premier, cover 553,005 members in North Carolina, Ohio and Virginia. Sentara is the sixth-largest insurer in Virginia.

Blue Cross of Idaho will expand its value-based care arrangements to 15 partnerships, encompassing more than 3,000 providers, for the 2023 plan year. The insurer said 70% of its member claims were processed through its value-based arrangements, which cover its Affordable Care Act exchange, Medicare Advantage and commercial offerings, in 2022. The Blues affiliate is currently the largest insurer in its home state, with 554,670 members.

Intermountain Healthcare is partnering with Aurora, Colo.-based health system UCHealth to expand its insurance offerings to Colorado. The value-based care focused initiative will create an integrated network of more than 700 primary care physicians across hundreds of sites-of-care, and bring SelectHealth’s Medicare Advantage and Affordable Care Act exchange products to Colorado in 2024. SelectHealth, Intermountain’s health insurance subsidiary, currently serves 995,185 members across Idaho, Nevada and Utah. It is the largest insurer in Utah.