As publicly traded insurers vie for contracts in an increasingly competitive Medicaid environment, this year has seen a considerable uptick in bid protests and legal challenges with billions of dollars at stake. Dayton, Ohio’s CareSource, one of the largest not-for-profit Medicaid insurers in the U.S., has participated in at least five such protests after embarking on an aggressive market expansion. And while its approach involving strategic partnerships with local providers has had mixed results, the insurer is intent on pursuing states where it believes it can best serve enrollees, whether that be through Medicaid or other product lines.

CareSource currently serves 2.1 million enrollees in Medicaid, Affordable Care Act exchange and dual eligible plans. According to AIS’s Directory of Health Plans (DHP), nearly 1.8 million (or about 85%) of those lives are in Medicaid or duals plans in Georgia, Indiana, Michigan and Ohio. Its home state of Ohio is its largest Medicaid market, where it serves approximately 1.2 million individuals.

Legal experts during a recent panel discussion said federal agencies and lawmakers have new uncertainty around health care regulation in the aftermath of the Supreme Court’s decision to end a legal concept that gave agencies broad leeway when they issued rules.

In its rulings in Relentless v. Department of Commerce and Loper Bright Enterprises v. Raimondo, the Supreme Court effectively repealed Chevron deference, a legal precedent that is more than 40 years old. The idea behind it is that agency staff have subject matter expertise that Congress is unlikely to share, and Congress couldn’t be expected to continually update statutes to address every emerging issue of importance to a specific sector of the economy.

With Vice President Kamala Harris now poised to get the Democratic nomination for president, Wall Street analysts have been busy prognosticating what that means for the array of for-profit health care firms they cover — including health insurers.

So far, select analysts are predicting that Harris’ ascendence will give Democrats a greater chance of winning the election, which would be bad news for Medicare Advantage-focused insurers but good for those more focused on Medicaid and the Affordable Care Act exchanges.

According to the latest data from KFF’s Medicaid Enrollment and Unwinding Tracker, more than 24.5 million people have been disenrolled from Medicaid as of July 23. Among reporting states, there is wide variation in Medicaid disenrollment rates, KFF noted, ranging from 57% in Montana to 12% in North Carolina. The nonprofit foundation said some of that variation is likely explained by “who states are targeting with early renewals as well as differences in renewal policies and system capacity.” Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 53.6 million enrollees, had their coverage renewed, KFF said. Still, the foundation noted that “due to varying lags for when states report data, the data reported here undercount the actual number of disenrollments to date.”

Molina Healthcare, Inc. has agreed to pay $350 million to acquire ConnectiCare, a subsidiary of EmblemHealth that covers about 140,000 medical lives in Connecticut. The July 23 announcement occurred one day before Molina reported second-quarter earnings results that beat Wall Street analysts’ projections. The ConnectiCare deal is expected to close in the first half of next year and is subject to regulatory approvals.

Centene Corp., meanwhile, reported second-quarter financial results on July 26 that underscored the elevated cost trends it’s seeing in its dominant Medicaid segment. Like other insurers, Centene is feeling the effects of a higher-acuity risk pool created by the exodus of millions of people from the Medicaid rolls since states restarted routine eligibility checks last spring. Still, other positive developments for Centene led one Wall Street analyst to declare its quarterly performance “mixed.”

Another state attorney general, Vermont Democrat Charity Clark, has filed a lawsuit against prominent PBMs — in this case, The Cigna Group’s Evernorth and CVS Health Corp.’s Caremark. According to a July 17 press release from Clark’s office, the two PBMs “control approximately 95% of the commercial market in the state” and “as a result, they have a hand in nearly every prescription transaction and have near complete control over the pricing, dispensing, and reimbursement systems.” The press release alleges that the two PBMs “grant placement on their standard formularies to the prescription drugs with the largest payments from manufacturers and the highest list prices, while excluding lower-cost prescription drugs.” Arkansas Republican Attorney general Tim Griffin recently sued UnitedHealth Group’s Optum Rx and Evernorth over their alleged roles in the opioid epidemic. And in 2023, Ohio Attorney General Dave Yost filed a lawsuit accusing Express Scripts, Prime Therapeutics, Humana Pharmacy Solutions and Ascent Health Services of colluding to drive up drug prices.

Despite reporting a strong balance sheet for the second quarter of 2024, Elevance Health, Inc. faced a selloff that seemed to be prompted by higher-than-expected utilization in the insurer’s Medicaid book of business. On July 17, the day that Elevance reported its results, its stock price dropped by $32.21 over the full day of trading, a 5.82% decrease, to settle at $520.93 — despite year-over-year increases in operating gain and operating margin, as well as better-than-expected medical loss ratio (MLR) performance.

Elevance took in $43.2 billion in operating revenue in the quarter, down $200 million year over year. Its operating gain increased by $200 million year over year to $2.8 billion, and operating margin increased by 0.3% year over year to 6.4%. Elevance posted an MLR of 86.3%, below the Wall Street consensus of 86.4%.

Although multiple Wall Street analysts deemed UnitedHealth Group’s second-quarter financial results “messy,” they also suggested that the company’s near-term stumbling blocks are largely eclipsed by the prospects of a more favorable 2025.

The “messy” moniker — used by Bernstein Research’s Lance Wilkes, Raymond James’ John Ransom and Wells Fargo’s Stephen Baxter — largely refers to UnitedHealth’s adjusted medical loss ratio (MLR) of 84.5% in the quarter. During UnitedHealth’s July 16 earnings conference call, Chief Financial Officer John Rex said that figure included an impact of 40 basis points, or $290 million, related to the suspension of some care management activities after the Change Healthcare cyberattack that hit the claims-processing subsidiary earlier this year.

As states resumed their Medicaid eligibility redeterminations last spring, some experts suggested that officials should prioritize helping Medicaid managed care (MMC) enrollees who were losing coverage enroll in a plan from the same carrier in the Affordable Care Act (ACA) individual marketplace. Private insurers like Centene Corp. have also emphasized this strategy, with the goal of stemming member attrition. However, a new study from Health Affairs suggests that “a within-carrier transition is likely to be possible only for roughly half of Medicaid managed care enrollees.”

By examining Clarivate’s InterStudy enrollment data from 2021, researchers found that in 2021, 52.1% of MMC members were enrolled by a carrier that also had a plan on the ACA marketplace in the same county. Among all MMC enrollees, 24.5% were in counties where the largest insurer was the same in both Medicaid and the ACA marketplace. In 10.3% of the 2,625 counties with MMC, all MMC enrollees were in a plan offered by an insurer that also had a marketplace plan.

Most state Medicaid programs require managed care plans to cover some common treatments and medications for substance use disorder (SUD), according to a study published this month in Health Affairs. However, Lauren A. Peterson, one of the study’s authors, tells AIS Health, a division of MMIT, it is “concerning” that only half of the states that contract with managed care plans require coverage of all treatments and services recommended by the American Society of Addiction Medicine (ASAM).

While Peterson, a Ph.D. candidate at the University of Chicago, acknowledges that “states are really making a commitment to cover [SUD treatments],” she says she and her co-authors agree with ASAM that all SUD treatments should be available.