AIS’s Directory of Health Plans

Datapoint: Florida Unveils Medicaid Contract Awards

Five managed care organizations, including a subsidiary of Centene Corp., were chosen for new contracts to serve those enrolled in the Statewide Medicaid Managed Care program. Reducing its current vendor roster of nine, Florida on April 12 unveiled its intent to award statewide contracts to Elevance Health, Inc.’s Simply Healthcare Plans, Inc., Centene’s Sunshine State Health Plan, Inc. and Humana Inc.’s Humana Medical Plan, Inc. Community Care Plan and Florida Community Care, LLC, were also chosen to serve five out of eight regions in the state. Incumbents Aetna Better Health, AmeriHealth Caritas Florida, Molina Healthcare of Florida and UnitedHealthcare of Florida did not win any regions but have the option to contest the results. The state currently serves 3,605,775 managed Medicaid beneficiaries.

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Datapoint: Clover Health to Settle Shareholder Lawsuits

Clover Health Investments Corp. said on April 4 that a federal district court preliminarily approved its settlement agreement to resolve multiple shareholder-filed lawsuits against the Medicare Advantage startup. Clover had faced several class-action lawsuits that accused it of concealing material information from investors — including an active Dept. of Justice investigation — when it went public in 2021. In April 2023, Clover agreed to pay$22 million to pay one of the consolidated shareholder lawsuits against it. The more recent settlement agreement — which was first disclosed last June and received preliminary court approval on March 5 — would resolve the remaining shareholder-led civil cases filed against Clover in Delaware, New York, and Tennessee courts. While this settlement does not involve any monetary payment, it will require Clover to “implement a suite of corporate governance enhancements.” The startup currently serves 78,129 Medicare Advantage members in five states.

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Datapoint: Michigan Awards Medicaid Contracts

The Michigan Department of Health and Human Services last week awarded contracts to nine payers to serve the state’s Medicaid managed care program. All nine payers are incumbents to the program, with the 5-year contracts slated to begin Oct. 1. Michigan currently serves 1.74 million Medicaid managed care beneficiaries. Its three largest payers are Centene Corp. (373,000 members), Molina Healthcare (303,000 members) and Blue Cross Blue Shield of Michigan (265,000 members).

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Datapoint: UCare Partners With Violet to Train Providers in Cultural Competency

UCare, the largest managed Medicaid insurer in Minnesota, is partnering with tech company Violet to improve inclusivity and cultural competency in its care delivery. Violet’s training platform educates health care providers on health disparities and best practices that can improve clinical outcomes for culturally diverse patients. “Violet’s equity-centered, community-specific courses offer tools for our clinicians and non-clinical staff to learn, ask questions about what works or doesn’t work, for whom and why and identify new ways to provide inclusive care for our members,” UCare Health Equity Officer Pleasant Radford, Jr. said in a statement. UCare currently serves 354,910 Medicaid beneficiaries in Minnesota.

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Datapoint: GA Medicaid Expansion Could Bring Coverage to 300,000 People

Nearly 300,000 people would gain health coverage if Georgia expanded Medicaid, according to a new analysis prepared by the Urban Institute with support from the Robert Wood Johnson Foundation. The report found about 28% of the uninsured people in the state would gain insurance coverage if Georgia expanded Medicaid eligibility to up to 138% of the federal poverty level, and the state would go from having the eighth-highest uninsured rate to the 24th-highest. Georgia is one of 10 states that have not expanded Medicaid under the Affordable Care Act. It currently serves 2,762,293 Medicaid and CHIP beneficiaries, with 75% enrolled in managed care plans.

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Datapoint: Point32Health Nixes Home Care Utilization Management

Starting on April 12, Point32Health will not require utilization management for home care services for nearly all members in commercial plans during the first 30 days after discharge from a hospital. The insurer, whose affiliates are Harvard Pilgrim Health Care and Tufts Health Plan, announced the change in an April 2 press release. The company said it will continue to require prior authorization after the initial 30 days post-discharge for home care services, including physical therapy, occupational therapy, home health aides and nutritional counseling. Point32Health currently serves 668,575 commercial risk-based members in five New England states, plus an additional 636,785 members via self-funded arrangements.

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Datapoint: Oklahoma Launches Medicaid Managed Care

Oklahoma’s transition to Medicaid managed care began April 1, according to a local ABC News station. The new program, SoonerSelect, replaces SoonerCare, the state’s fee-for-service system, for many Oklahomans. Beneficiaries were automatically enrolled in plans offered by CVS Health Corp.’s Aetna, Humana Inc. and Centene Corp., but have the option of switching to a new plan by June 30. Oklahoma currently serves 930,328 Medicaid and CHIP beneficiaries.

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Datapoint: Kaiser to Launch PACE Plans

Kaiser Permanente on March 27 said it is partnering with investment firm Town Hall Ventures to launch new products under the Program of All-Inclusive Care for the Elderly (PACE) model. The new venture will be known as Habitat Health, and will begin serving seniors in Sacramento and Los Angeles in 2025, with a national expansion to follow. “We have an extraordinary challenge in this country,” Andy Slavitt, general partner with Town Hall Ventures, said in a statement. “The number of people age 85 and older in our country will double by 2040. We need a better answer for the millions of older adults that is more humane, compassionate, scalable, and affordable for the nation.” Just under 60,000 people nationwide are currently enrolled in PACE plans, with 14,898 residing in California. Leading the California market is AltaMed PACE, which serves 2,913 members as of March 2023.

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Datapoint: Exchange Sign-Ups See 31% Annual Increase

More than 21 million people selected or were automatically reenrolled in health plans during the most recent Affordable Care Act open enrollment period (OEP). That’s according to one of four reports issued by HHS on March 22 marking the 10-year anniversary of the ACA. HHS also said that 5.1 million more people signed up for coverage during the 2024 OEP compared to the 2023 OEP, representing a 31% increase. The three largest exchange insurers as of the latest update to AIS Health’s Directory of Health Plans are Centene Corp. (3.6 million members), Florida Blue (1.2 million members) and Aetna (1.1 million members).

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Datapoint: Nevada Gets Approval for Medicaid Housing Program

CMS earlier this month gave Nevada the go-ahead to implement a pilot program that will provide housing and other supportive services to Medicaid beneficiaries in need, according to a report in the Nevada Current. The new Section 1115 waiver will allow Medicaid to cover up to six months of rent, temporary housing and utility payments, as well as meals for the duration of the housing period. The pilot will start with an estimated 20,300 beneficiaries, according to the news outlet. Nevada’s Medicaid program currently serves 807,545 beneficiaries, with 83.5% enrolled in managed care plans.

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