AIS’s Directory of Health Plans

Centene Corp. agreed to pay the state of South Carolina nearly $25.9 million to settle allegations it overcharged the state’s Medicaid program for pharmacy services. Centene did not admit any wrongdoing in the settlement, which South Carolina Attorney General Alan Wilson announced in a Dec. 29 press release. Centene has settled similar allegations with several other state Medicaid programs and said in 2021 that it had set aside $1.25 billion to settle such lawsuits. Centene is currently the second-largest Medicaid managed care insurer in South Carolina, serving 215,477 lives.

Elevance Health, Inc. has agreed to acquire Paragon Healthcare, a company that provides infusion services to patients. Elevance announced the pending transaction on Jan. 4 and said it expects the deal to close in the first half of this year. The companies did not disclose financial details, but Axios reported Elevance will pay more than $1 billion for Paragon, which operates in Alabama, Colorado, Florida, Georgia, Missouri, Oklahoma, Tennessee and Texas. If the deal closes, Paragon will become part of CarelonRx, Elevance’s pharmacy services segment. Elevance is currently the second-largest insurer in the U.S., serving 37,429,058 members.

Startup insurer Devoted Health, which offers Medicare Advantage plans and has a virtual-first and in-home medical group, raised $175 million in a Series E funding round. A syndicate of The Space Between, Highbury Holdings, GIC, Stardust Equity, Maverick Ventures and Fearless Ventures led the round, according to a Dec. 29 press release. Modern Healthcare reported the latest round values Devoted Health at $12.9 billion, up from a valuation of $12.7 billion when the company raised $1.15 billion in a Series D round. The insurtech currently serves 140,797 members in 13 states.

Cigna Healthcare is in “exclusive talks” to sell its Medicare Advantage business to Health Care Service Corp. for between $3 billion and $4 billion, according to a Jan. 3 report in the Wall Street Journal. The report comes shortly after Bloomberg cited anonymous sources saying HCSC and Elevance Health were interested in acquiring Cigna’s Medicare business, a segment the company entered in 2012 through its acquisition of HealthSpring. Cigna has struggled to compete in Medicare with market leaders such as UnitedHealth Group and Humana Inc., with 593,441 MA and dual eligible members as of December 2023.

Kansas Gov. Laura Kelly (D) on Dec. 14 unveiled the Cutting Healthcare Costs for All Kansas Act, which would expand Medicaid to individuals whose incomes are up to 138% of the federal poverty level. The proposal, however, comes with a requirement that individuals must submit proof of work or community engagement when applying for coverage and again when the coverage renews a year later. Although states pay 10% of the costs to expand Medicaid, Kelly noted that the state would not bear any of the additional costs and that the state would instead cover its share via drug rebates, a hospital fee and other means. If approved, the expansion would go into effect on Jan. 1, 2025. Kansas currently serves 485,029 Medicaid beneficiaries, with 92.7% enrolled in managed care plans.

Molina Healthcare, Inc. on Jan. 2 finalized its $425 million purchase of struggling insurtech Bright Health’s last remaining insurance assets, its California Medicare Advantage plans. The deal nets Molina 121,863 MA members, boosting its membership by 115%, according to AIS’s Directory of Health Plans.

South Dakota legislators are looking to resurrect a Medicaid work requirement that failed in the state Senate last year, the Rapid City Journal reported. The provision would apply to nondisabled members of the state’s new Medicaid expansion population. Expansion was approved by ballot initiative in November 2022. Of South Dakota’s 123,775 Medicaid beneficiaries, 15,050 are currently enrolled in Medicaid expansion.

Elevance Health’s deal to buy Blue Cross and Blue Shield of Louisiana is back on, Nola.com reported Dec. 14. The two insurers submitted a new proposal that gives the state more oversight of the Accelerate Louisiana Initiative, the health equity nonprofit that will be established by the sale. State officials and local provider groups were previously unhappy with the deal’s incorporation structure. The Louisiana Blues insurer is currently the second-largest in its home state, behind UnitedHealthcare, with 1,056,454 members.

Blue Shield of California is helping its members treat heart disease from home with its new partnership with Ornish Lifestyle Medicine. The 9-week program offers food and equipment delivery, while virtual classes and coaching supports lifestyle interventions and group support. The new benefits are available for members enrolled in employer group, individual and family and Medicare PPO plans with a history of heart disease or who have experienced a cardiac event. Blue Shield of California currently serves 3,029,551 members in its home state, with 65.2% enrolled in employer-based products.

InnovAge Holding Corp., the leading provider of Programs of All-Inclusive Care for the Elderly (PACE), on Dec. 1 completed its previously announced acquisition of two PACE programs in California from ConcertoCare. With the addition of the ConcertoPACE programs, InnovAge now operates 18 PACE centers in five states, with four additional PACE centers under development, according to a company press release. Combined, the two new ConcertoPACE programs are expected to add additional capacity for approximately 750 participants at maturity, said InnovAge. ConcertoCare is a tech-enabled, value-based provider of at-home, comprehensive care for seniors and other adults with unmet health and social needs. InnovAge currently enrolls 5,691 PACE members.