Managed Medicaid

Public Coverage Is Up, Private Coverage Is Down — Yet Likely Not for Long

The uninsured rate dipped slightly between 2020 and 2021, and while private insurance continued to be the most common type of coverage, it decreased in prevalence while government coverage increased, according to new data from the U.S. Census Bureau. One Wall Street analyst suggests that the findings are unsurprising given the current policy and demographic landscape, but he notes that trends are poised to change considerably when millions cease to qualify for Medicaid.

The Census Bureau’s survey, conducted between February and April, asked individuals whether they had any type of health coverage in the past calendar year. In 2021, 8.3% of the U.S. population lacked health insurance, compared to 8.6% in 2020. Put another way, 27.2 million Americans did not have coverage last year, down from 28.3 million the year prior. The 2021 uninsured rate of 8.3% represented a small uptick compared to 2019, however, when it reached a low of 8.0%.


TennCare Acquiesces to CMS’s Demands for Demo Revisions

Bowing to CMS’s request after another public comment period, Tennessee is reluctantly pursuing a series of changes to the pending TennCare III demonstration that had been approved by the Trump administration for a start date of Jan. 8, 2021. In what one source says is an unusual back-and-forth on public display, the state will abandon its notorious plans to implement a closed Medicaid formulary and adopt a fixed funding mechanism.

Shortly before President Joe Biden took office, the Trump administration in January 2021 approved Tennessee’s request to use an “aggregate cap” for Medicaid funding that many industry observers had likened to a block grant. Through that approach, Tennessee would have received federal Medicaid funds based on a fixed budget target that is determined by CMS and the state using historical enrollment and costs data. If spending fell below that target cap but certain quality goals were met, the state would earn up to 55% of annual savings to reinvest back into other state health programs.

Health Insurers, Feds Gear Up to Steer People to ACA Marketplaces

With a law finally passed that extends enhanced Affordable Care Act subsidies for another three years, health insurers and government agencies can now start their consumer-outreach campaigns for the upcoming open enrollment period in earnest. But they’ll also be prepping for a bigger challenge down the road: Ensuring a smooth transition for people who will no longer be covered by Medicaid after the COVID-19 public health emergency (PHE) ends.

To that end, the Biden administration on Aug. 30 rolled out a plan called the “Assister Strategy to Support Medicaid Unwinding.” As part of that plan, HHS said it’s allocating $100 million to Navigator grantee organizations for the 2022-2023 budget period as well as reviving the Enrollment Assistance Program (EAP), which established temporary storefronts and labor forces that the Obama administration used in the ACA marketplaces’ early years to supplement Navigators’ outreach efforts. For the new version of the EAP, the Biden administration will deploy “mobile assisters” across population centers identified by HHS.


Multiple States Set Sights on Medicaid Expansion in Coming Election; Millions Could Gain Eligibility

About 3.7 million people could gain access to health care if the current 12 nonexpansion states were to fully implement a Medicaid expansion in 2023, according to a recent Urban Institute analysis.

In the upcoming gubernatorial elections in November, Medicaid expansion could be a key issue in several nonexpansion states, including Wisconsin, Kansas and Georgia. All three states had several failed attempts to fully expand Medicaid eligibility.


News Briefs: Biden Admin Takes Steps to Streamline Medicaid, CHIP Eligibility

CMS on Aug. 31 proposed a new regulation aimed at streamlining applications, verifications, enrollment and renewals for Medicaid and Children’s Health Insurance Program (CHIP) coverage. The rule would make a host of changes, such as eliminating the requirement that individuals apply for other benefits as a condition of Medicaid eligibility, requiring that states conduct renewals no more than once every 12 months, and establishing specific guidelines for states to check available data prior to terminating eligibility when a beneficiary cannot be reached due to returned mail. CMS said it estimates that “this proposed rule would remove barriers to enrollment and increase the number of eligible individuals who obtain coverage and are continuously enrolled in Medicaid and CHIP.”


Medi-Cal Awards Diss Centene With Reduced Service Area

As part of a Medicaid managed care revamp and its first statewide competitive procurement for the Medi-Cal program, the California Dept. of Health Care Services (DHCS) on Aug. 25 named the three insurers that will serve as commercial managed care plans (MCPs) in 2024. Elevance Health’s Anthem Blue Cross Partnership Plan, Centene Corp.’s Health Net and Molina Health Care were selected to participate in varying service areas across 21 counties. Health Net’s loss of three counties, however, spooked investors as Centene already faces declining Medicaid enrollment and continues to settle allegations of mishandling Medicaid pharmacy benefits in multiple states, the latest being Washington.

Amid Inflation, Possible Recession, Insurers Are on Strong Financial Footing

Despite worrying macroeconomic trends, health insurers have done well this year so far, with all the largest publicly traded health insurance firms posting year-over-year earnings growth in the first half of 2022. Experts tell AIS Health, a division of MMIT, that they don’t expect health insurers to struggle despite ominous signs across the economy.

Those headwinds include inflation; a possible recession, which could decimate employer-based insurance enrollment; medical cost growth; and the resumption of Medicaid eligibility redeterminations, which will force unprecedented amounts of disenrollment. But experts say that insurers with a mix of business lines should be in a strong financial position. The largest risk is likely to insurers that carry a coverage mix disproportionately focused on the commercial market.


Inclusa Deal Will Give Humana Greater Foothold in Wisconsin, Medicaid

Fresh off of touting its organic Medicaid growth during its second-quarter 2022 earnings call, Humana Inc. recently unveiled an acquisition that will help the insurer grow its Medicaid business inorganically as well. Industry analysts say it’s a sound strategic move, but they add that Humana’s growing Medicaid assets aren’t likely to eclipse its focus on Medicare Advantage anytime soon.

The Louisville, Ky.-based company said on Aug. 12 that it will purchase substantially all the assets of Inclusa, which provides long-term services and supports to about 16,600 older adults and adults with disabilities through Wisconsin’s Family Care program. Humana already has a Medicaid presence in Wisconsin, having purchased the insurer iCare there in 2020.


News Briefs: More States Extend Medicaid Postpartum Coverage

HHS on Aug. 16 approved the extension of Medicaid and Children’s Health Insurnace Program (CHIP) coverage for 12 months after pregnancy in Hawaii, Maryland and Ohio. Combined with previously approved state extensions made possible under the American Rescue Plan Act, 21 states and the District of Columbia now offer a full year of postpartum Medicaid/CHIP coverage. Separately, CMS issued a notice of proposed rulemaking on Aug. 18 that aims to require mandatory, annual state reporting of three quality measure sets: the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP; the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid; and the Core Sets of Health Home Quality Measures for Medicaid. The quality measures “will allow us not only to identify health disparities but also to implement interventions based on the very data that make those disparities clear,” said CMS Administrator Chiquita Brooks-LaSure.


Mississippi Medicaid Plays Musical Chairs With MCOs, Trades UHC for CareSource Affiliate

Despite a challenge earlier this year to its longstanding pact with Mississippi Medicaid, Centene Corp. on Aug. 10 said its Magnolia Health Plan subsidiary was selected to continue serving the Mississippi Coordinated Access Network (MississippiCAN) and the Mississippi Children’s Health Insurance Program (CHIP). Meanwhile, the state’s Division of Medicaid (DOM) unveiled its intent to award new four-year contracts to two other insurers, including new entrant and CareSource affiliate TrueCare, which will bump leading managed care organization UnitedHealthcare out of the market.

Centene over the past year has reached multiple settlements with states regarding its handling of Medicaid pharmacy benefits. In June 2021, the health care giant agreed to pay $55.5 million to Mississippi after a 2019 investigation by the Office of the State Auditor concluded Centene’s pharmacy benefit manager was overbilling the state.