Medicaid Managed Care

News Briefs: Many Medicaid MCOS Have Health Equity Strategies

More than half of Medicaid managed care organizations have health equity strategies for some of their members, while four in 10 have health equity plans for their entire membership, according to a survey from the Institute for Medicaid Innovation (IMI). The survey found that 48% of MCOs have pursued health equity accreditation from the National Committee for Quality Assurance (NCQA), with 33% “planning to pursue” the accreditation. And 14% have no plans to do so, while 5% didn’t respond. Meanwhile, 86% of MCOs have “programs/policies for health plan internal staff” that are meant to address structural racism or promote racial equity, and 48% have policies for members that do the same. Outside of racial equity concerns, other notable findings from the survey include widespread problems with care coordination and telehealth delivery: 71% of responding MCOs said “access to information from previous providers [is] a key barrier to care coordination,” while 67% said “their information technology systems were a barrier to setting up effective telehealth delivery services.”


Pandemic-Transformed Medicaid Faces Looming Eligibility Challenge

At some point in the next year, it’s likely that Medicaid eligibility redeterminations will resume — a process that will be kicked off when the Biden administration declares an end to the COVID-19 public health emergency (PHE). Medicaid has hit record-high enrollment this year, meaning states and managed care organizations will have to contact more people than they ever have before in a short period of time; meanwhile, MCOs will also have to deal with looming cuts to reimbursement and rising provider rates.

Margins for MCOs seem likely to shrink. Provider rate increases are coming soon, though it’s likely that they will vary in timing and scope depending on market and contract cycles. However, the pricing effects of workforce shortages and inflation will impact every plan and provider, sources previously told AIS Health.


Centene Posts Solid 3Q Results Despite Wall Street Concerns

Centene Corp. managed to beat Wall Street’s earnings expectations in the third quarter of 2022 while also reporting lower-than-expected Medicare Advantage Star Ratings and MCO contract struggles in California and Florida, two of the Medicaid-focused carrier’s largest states by enrollment. Reviews from Wall Street analysts were mixed, with financiers praising Centene’s continued efforts to spin off its PBM business but raising concerns over the contract disputes and the looming resumption of Medicaid eligibility redeterminations.

The insurer reported $1.30 in adjusted earnings per share (EPS), beating the Wall Street consensus projection of $1.24. Membership grew by 322,400 to over 26.7 million total members during the quarter, raising the year’s cumulative enrollment growth to nearly 950,000 members. Executives project an end-of-year EPS of $5.65 to $5.75, slightly up from a previous projection of $5.60 to $5.75. Centene’s medical loss ratio was 88.3%, and its total revenues reached $35.9 billion in the quarter, up 11% compared with the third quarter of 2021.


Driven by Health Care Services, Low MLR, Elevance Posts Strong Third Quarter

Elevance Health, Inc. (formerly Anthem) released its third-quarter financial results on Oct. 18, beating Wall Street consensus earnings projections and receiving praise from financial analysts. The insurer — which claims it passed UnitedHealth Group in total enrollment this year — said growing membership, the performance of the commercial insurance and health care services divisions, and lower-than-expected utilization all contributed to the strong results.

The managed care giant reported $7.53 in adjusted earnings per share (EPS), beating the Wall Street consensus projection of $7.15. Membership grew by 232,000 to 47.3 million total members during the quarter, raising the year’s cumulative enrollment growth to 2.2 million. Executives project a fourth-quarter dividend of $1.28 per share, with end of year EPS “greater than $28.95 per share,” according to a press release.


UnitedHealth 3Q Earnings Call: Execs Talk Redeterminations, Acquisitions, Inflation

During UnitedHealth Group’s recent conference call to discuss third-quarter 2022 financial results, executives discussed a variety of topics in addition to the company’s earnings — including broad-based trends like inflation and the looming return of Medicaid redeterminations, as well as UnitedHealth’s strategies for integrating a recent acquisition and furthering risk-based payment models.

Overall, equities analysts seemed satisfied with both UnitedHealth’s quarterly performance and its plans to overcome potential headwinds going forward.


News Briefs: Share of Highly Rated MA-PD Plans Will Drop in 2023

On Oct. 7, CMS released the 2023 Medicare Advantage Star Ratings, revealing that 51.3% of Medicare Advantage Prescription Drug (MA-PD) plan contracts will be rated 4 stars and above next year. That’s down from 68.4% of 2022 MA-PD contracts, Citi analyst Jason Cassorla observed in a note to investors. On an enrollment basis, 72.1% of current MA-PD enrollees are in plans rated 4 stars and above for 2023, down from 89.7% in 2022. “The lower MA Star Ratings for 2023 on a [year-over-year] basis are largely a function of CMS removing many of the COVID-19-related guardrails and relaxed criteria that aided Stars performance for 2021-2022,” Cassorla pointed out. “Ratings for 2023 were also impacted by changes to how plans are rated with CMS a greater emphasis on the Consumer Assessment of Healthcare Providers and Systems survey.”


Medicaid MCOs Will Aid Ambitious New Waiver Demos in Massachusetts, Oregon

Recently, the Biden administration approved a pair of wide-ranging Medicaid waiver demonstration programs in Massachusetts and Oregon, granting those states authority to test unique policies such as keeping certain populations enrolled in Medicaid for more than a year and covering clinically tailored housing and nutritional supports. Medicaid managed care plans that serve Massachusetts and Oregon tell AIS Health that they’re planning to play a major role in helping to implement the new waiver programs, which will allow them to expand some of the social-needs-based interventions that they’re already providing and reduce the enrollee churn that can stymie care-management efforts.