AIS’s Directory of Health Plans

Datapoint: MI Blues to Purchase Specialty Insurance Company

Blue Cross Blue Shield of Michigan subsidiary AF Group last week said it has entered an agreement to purchase AmeriTrust Group, an insurance company that offers specialty products including workers’ compensation, commercial package and automotive business coverages. The deal will bolster BCBSMI’s diversification efforts and mitigate the financial impact of the COVID-19 pandemic, the press release detailed. The Blues affiliate is currently the largest insurer in Michigan, with 4,520,146 members — 43.1% of the state’s medical lives.

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Datapoint: Sidecar Health to Launch Insurance Products in Ohio

Philadelphia-based insurtech startup Sidecar Health last week launched its first fully insured health plans, targeting employer groups of 51+ people in Ohio. Sidecar, founded in 2018, has traditionally offered its members non-ACA compliant direct pay plans, leveraging new pricing transparency laws. The top three group risk-based insurers in Ohio are Anthem, Inc (533,807 lives), Medical Mutual of Ohio (252,810 lives) and UnitedHealthcare (205,596 lives).

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Datapoint: California Is Investigating Centene’s Medicaid Drug Management

The California Health Care Services Department is investigating Centene Corp. in relation to its management of Medicaid drug benefits, according to a Kaiser Health News report that ran in the Los Angeles Times. Centene last year acquired Magellan Health, which administrates California’s Medicaid prescriptions. Centene’s health insurance units currently serve 1,702,364 Medicaid beneficiaries in California.

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Datapoint: Michigan Creates Prior Authorization Reform Law

Michigan Governor Gretchen Whitmer (D) last week signed into law the Health Can’t Wait Act, which decreases wait times for health care services and prescriptions that require prior authorization. The bill also obligates insurers to provide its members with more information about the prior authorization process. Approximately 10.5 million people have full medical coverage in Michigan, with Blue Cross Blue Shield of Michigan (4,520,146 lives), Priority Health (1,138,268 lives) and UnitedHealthcare (756,330 lives) serving as the state’s three largest insurers.

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Datapoint: CMS Expands Postpartum Medicaid Coverage

The Biden administration on April 1 unveiled a new Medicaid enhancement, allowing states to extend Medicaid and CHIP coverage to postpartum beneficiaries for an additional 12 months. The new plan could impact as many as 720,000 people, according to CMS. Louisiana is the first state to begin offering this form of coverage, estimated to impact about 14,000 people. The state currently serves 1,941,505 Medicaid beneficiaries, with 91.5% enrolled in a managed care plan. Nine other states are also working on implementing the program.

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Datapoint: Intermountain, SCL Health Complete Merger

Two nonprofit health systems, Salt Lake City’s Intermountain Healthcare and Broomfield, C.O.-based SCL Health, have completed their planned merger, according to an April 5 press release. The combined $11 billion system operates 33 hospitals and 385 clinics in Utah, Idaho, Nevada, Colorado, Montana, Wyoming, and Kansas. Intermountain also operates Utah’s largest insurer, SelectHealth, which currently enrolls 32.2% of the state’s overall insurance market with 825,108 lives.

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Datapoint: Georgia Passes Mental Health Parity Law

Georgia Governor Brian Kemp (R) on April 4 signed into law a bill that requires health insurers to cover mental health and substance abuse care as if it were traditional medical care. The new law will go into effect in July. More than 10 million people have full medical coverage in Georgia, with Anthem, Inc. (3,183,977 lives), Centene Corp. (1,406,039 lives) and UnitedHealthcare (917,764 lives) serving as the three largest insurers.

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Datapoint: United to Purchase Major Home and Hospice Provider

Following Humana’s lead, UnitedHealth Group last week announced its health services arm Optum is set to acquire LHC Group, a large home care and hospice provider, for $5.4 billion. The deal is expected to close in the second half of 2022. UnitedHealth currently operates the largest commercial health insurer in the U.S., with 45,814,482 members.

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Datapoint: Florida Blue Launches In-Home Primary Care

Florida Blue this week unveiled a new in-home primary care program for its Medicare Advantage members in partnership with Emcara Health. Florida Blue members in 17 counties, including the Orlando, Tampa and Miami metro areas, will be eligible for the new benefits, which include home-based primary care doctors, in-home nursing visits and community health workers who can facilitate transportation and meal benefits. Florida Blue parent company GuideWell currently serves 181,575 MA lives in the state.

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Datapoint: Florida Suspends Centene’s Medicaid Plan

The state of Florida last week fined Centene Corp. $9.1 million and suspended enrollment in its Medicaid and long-term care plans following a spate of inappropriate claims denials caused by a computer error. The insurer has 30 days to pay the fine and submit a plan for how it will handle claims processing in the future. Centene currently enrolls 43% of Florida’s managed Medicaid market, with 1.81 million members.

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