AIS’s Directory of Health Plans

Minnesota last week awarded managed Medicaid contracts that will serve about 600,000 of the state’s Medicaid beneficiaries across 80 counties, according to an Oct. 7 report in the Star Tribune. The nine winners were Blue Cross and Blue Shield of Minnesota, HealthPartners, Hennepin Health, ITASCA Medical Care, Medica, PrimeWest, South Country Health Alliance, UCare and UnitedHealthcare, all incumbents to the program. The new contracts, which are slated to begin in January, will focus on how MCOs can better address social determinants of health and serve rural beneficiaries. Nonprofit insurer UCare currently operates the largest Medicaid MCO in Minnesota, serving 412,622 members, or 36.6% of the market.

Following 2020 legislation that ordered a transition to a state-based insurance exchange, Virginia last week awarded a contract to GetInsured to build the new marketplace. The tech company currently supports seven other state-based exchanges, with Virginia’s marketplace slated to open in the fall of 2023. 235,820 people are currently enrolled in exchange plans in Virginia, with Elevance Health leading the pack at 44.0% market share.

Pennsylvania Blues insurer Capital Blue Cross last week said it is partnering with Mark Cuban Cost Plus Drug Company (MCCPDC) to bring low-cost generic drugs to its members. MCCPDC charges consumers 15% more than its acquisition cost from the manufacturer, offering average savings of 80% on common generic drugs compared to retail prices. Capital Blue Cross is MCCPDC’s first payer partner, and the insurer said members can already begin accessing their prescriptions through MCCPDC online. Members will be able to use their insurance cards at MCCPDC locations next year. Capital Blue Cross currently serves 720,408 members in Pennsylvania, with 31.1% enrolled in commercial risk-based plans, and 62.6% in self-funded arrangements.

The New Mexico Human Services Department last week said it is seeking proposals from health insurers to serve the state’s managed Medicaid program. The current program, Centennial Care 2.0, will be renamed Turquoise Care when the new contracts begin 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 426,491 beneficiaries. Of New Mexico’s 878,632 full-risk Medicaid beneficiaries, 92.2% are enrolled in a managed care plan.

Portland, Ore.-based insurer Moda Health this week said it will expand its offerings to Idaho for the 2023 plan year. The insurer’s individual, family and employer group products will be available in 15 of the state’s counties. Moda Health currently enrolls 312,256 members, largely in Oregon, though it also has a small presence in Alaska and Texas. 49.2% of its members are enrolled in risk-based commercial products.

North Carolina will delay the launch of the next stage of its Medicaid managed care transformation from December 2022 to April 2023. The new Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans will provide specialized services to beneficiaries with significant behavioral health needs. The state began its transition to Medicaid managed care in March 2021, and currently enrolls 1,694,396 managed Medicaid members.

The Nebraska Department of Health and Human Services last week awarded 5-year Medicaid contracts to three insurers: incumbents UnitedHealthcare and Centene Corp., plus new entrant Molina Healthcare. Current contract-holder Elevance Health was not selected. Nebraska’s managed Medicaid plans currently serve 360,243 people.

A federal judge last week said UnitedHealth Group can complete its planned acquisition of Change Healthcare Inc. The Dept. of Justice previously sued UnitedHealth in an attempt to block the deal, alleging that acquiring Change would give UnitedHealth’s OptumInsight an anticompetitive edge in health data analytics. The judge, however, said the deal could go forward so long as UnitedHealth completes its announced plans to sell Change Healthcare's ClaimsXten division to private equity fund TPG Capital for $2.2 billion. With 46,614,669 members, UnitedHealth is the largest insurer in the U.S.

A panel of Kentucky appellate judges upheld the state’s challenged managed Medicaid contract awards, according to a Sept. 15 report in the Louisville Courier Journal. A lower court previously ordered the 2020 awards rebid, following a suit from Elevance Health, which was not initially selected to keep its contract. Parties have until Oct. 9 to further appeal the decision. Kentucky’s managed Medicaid population is currently served by six MCOs, led by Centene Corp., with 484,498 members. Elevance, meanwhile, serves 171,734 Kentucky Medicaid lives.

Highmark Health is partnering with value-based primary care provider AbsoluteCare to bring concierge-style primary care services to its public-sector members in Pittsburgh. Members will have access to same-day urgent care, behavioral health services and a pharmacy on-site. AbsoluteCare also operates in Atlanta, Baltimore, New Orleans and Philadelphia. Highmark is the largest insurer in Pennsylvania, with 2,342,027 members. It serves 324,557 managed Medicaid beneficiaries in the state.