AIS’s Directory of Health Plans

Startup insurer Clover Health will expand its Medicare Advantage presence in three states for the 2023 plan year; Georgia, South Carolina and Tennessee. The insurer also said it will leave two of its smaller markets, El Paso County in Texas and Pima County in Arizona. In a July 14 press release, Clover Health said it hopes its Georgia expansion replicates its previous success in New Jersey, by “significantly increasing the breadth and depth of its provider network throughout the state with the addition of dozens of hospitals, health systems and key provider partners across the region, aligning approximately 5,000 new primary care physicians and specialists.” Clover Health currently enrolls 84,948 MA members, with 82.7% enrolled in a New Jersey plan offering.

The state of Delaware this week awarded new Medicaid managed care contracts to three payers; incumbents Highmark Health and AmeriHealth Caritas, plus new entrant Centene Corp. "We are excited to work with the state and providers on proven models of value-based care to deliver transformative healthcare and improve the health of Diamond State Health enrollees across the state,” Brent Layton, president and chief operating officer with Centene, said in a July 12 press release. The new contracts, which are set to begin January 1, 2023, represent a shift to value-based care for the state. Delaware’s managed care plans currently serve 240,411 lives, representing 85.6% of the overall Medicaid population.

Alignment Healthcare on June 29 said it plans to expand its Medicare Advantage footprint into two new states, Florida and Texas, and into additional counties in the four states it currently serves. Pending CMS approval, the Orange, Calif.-based insurer will enter Clay, Duval, Manatee and Sarasota counties in Florida, and El Paso and Hudspeth counties in Texas for the 2023 plan year. Alignment says its latest expansion plans will enable it to reach an additional 1.1 million Medicare-eligible seniors, for a total of 8.2 million Medicare-eligible adults across 52 counties in six states next year. The insurer currently enrolls 94,544 MA members.

Insurance startup Oscar Health on June 29 unveiled a new member communication platform, its Next Best Actions engine. The messaging framework targets member behaviors, identifying patterns in opportunity to drive behavior changes and prioritizing the most important actionable messages for users. Oscar currently serves 1,037,360 members nationwide, with 92.1% enrolled in exchange plans.

Delaware Insurance Commissioner Trinidad Navarro last week announced that AmeriHealth Caritas and CVS Health’s Aetna will join the state’s exchange marketplace for the 2023 plan year. Currently, just one insuer, Highmark Health, offers exchange products in Delaware. Its plans serve 34,098 people according to the first-quarter 2022 update to AIS’s Directory of Health Plans.

California this month revoked Golden State Medicare Health Plan’s license, according to a June 22 report in the San Luis Obispo Tribune. Golden State’s 2,210 Medicare Advantage members will lose coverage August 1. The state took issue with the insurer’s lack of financial standing — it was running at a $35 million deficit in December 2021. Kaiser Foundation Health Plan is currently the MA market leader in California, with 1,308,719 members.

Colorado last week received approval from the federal government to launch the “Colorado Option” — a new state-sponsored health plan created by a Section 1332 State Innovation Waiver. The plan will aim to cover about 10,000 people, with the goals of increasing health statewide health coverage and reducing racial and economic disparities. 5,311,686 people currently receive medical insurance benefits in Colorado. 30.2% of those lives are enrolled in Colorado Medicaid.

In the latest settlement with a state Medicaid program over its pharmacy benefit practices, Centene Corp. has agreed to pay $13.7 million to the state of New Mexico. This is the seventh similar state settlement from the insurer, which has faced allegations of charging “layered fees” and obscuring its retail discounts from state Medicaid programs. Centene currently serves 86,167 Medicaid members in New Mexico, approximately 10.7% of the state’s managed Medicaid program.

Humana Inc. last week revealed new branding for its in-house pharmacy benefits services. Humana Pharmacy and Humana Specialty Pharmacy have been renamed CenterWell Pharmacy and CenterWell Specialty Pharmacy. Humana Pharmacy Solutions, Humana’s PBM, will not transition to the new branding. “Patients of CenterWell Specialty Pharmacy, which is payer-agnostic, can expect the same level of high quality personalized therapy management for chronic and complex illnesses, as well as customized clinical and educational services,” the company said in a statement. Humana is currently the sixth-largest payer in the U.S., serving 13,126,111 medical lives.

CVS Health Corp.’s Aetna, the third-largest insurer in the U.S., is canceling its contract with mental health startup Cerebral, according to reporting from Forbes. The telehealth provider was previously in-network for a large swath of Aetna members in 45 states. The startup is under investigation for possible violations of the Controlled Substances Act, which spurred Aetna to pull the plug. Aetna currently serves 22,222,764 medical lives, with 14.7% enrolled in commercial risk-based plans.