Thought Leadership

Our leading subject matter experts share their insightful analysis and points of view to help you stay abreast of industry trends

Why Updated Health Plan Enrollment Data Is Crucial in the Wake of Medicaid Changes

By Erin Trompeter

Due to the end of the public health emergency for COVID-19 and subsequent redeterminations for Medicaid, health plan enrollment data has become increasingly volatile.

As of this spring, states were able to resume Medicaid eligibility redeterminations, which were stopped during the pandemic. For three years, states couldn’t check members’ income to determine whether they were still under the income limits for Medicaid in their states, which caused Medicaid membership to increase steadily throughout the pandemic, particularly in the first year, when so many people lost their jobs. Now that states can disenroll beneficiaries who don’t meet income requirements, the opposite is happening, and Medicaid enrollment is decreasing for the first time in years. In addition, we expect to see a corresponding increase in health exchange enrollment and eventually in commercial group membership.

Medicaid Membership Changes

In the second quarter of 2023, AIS Health’s Directory of Health Plans (DHP) data showed that the most staggering changes occurred in the managed Medicaid segment. Due to eligibility redeterminations, Medicaid HMO enrollment decreased by more than 2.1 million from the first quarter of this year. It’s expected to continue to fluctuate, primarily decreasing, over the next year as states continue the redetermination process. Medicaid fee-for-service membership also fell, but only by 56,000, due to a lag time in data reporting capabilities. This segment is expected to increase more drastically in future updates.

The public health insurance exchange segment saw very small gains, adding 86,000 new members. It’s expected that this market will eventually see greater increases as those disenrolled from Medicaid search for new insurance options. Also, our Q2 data shows 125,000 new members up for grabs in the health exchange market as a result of plan closure; Friday Health Plans closed its doors due to financial difficulties.

Commercial group risk enrollment decreased since the first quarter, dropping more than 136,000 members, while administrative services only/self-funded members decreased as well (34,000). These segments could rebound if disenrolled Medicaid beneficiaries obtain employer-based insurance. Health exchange behemoth Centene Corporation gained nearly 200,000 new members in the second quarter due to its well-publicized strategy of reaching out to its recently disenrolled Medicaid beneficiaries. This could be a trend that other insurers follow.

Health Plan Data Updates Needed

Despite these fluctuations in Medicaid membership, some market share analysts are still not updating the enrollment data they use to make key sales decisions. By sticking with old data, companies risk missing out on these fluctuations, particularly at a carrier level, which means that they can’t target the right markets. While many national news sources are tracking this information at a state level, they’re not collecting insurer-level information. So, if a state reports in a news outlet that they’ve disenrolled 250,000 members in one month, this figure doesn’t break down which insurers lost how many members.

Additionally, lags in membership data can happen because Medicaid sources update their insurer-specific membership data at varying intervals. Some will report monthly, while others only update quarterly and upon request. And as it turns out, states have already had to walk back some of their disenrollments because members were dropped from the rolls mistakenly due to technical errors, so some states could rebound on membership a bit in the coming months.

The amount of change in the Medicaid marketplace (and across all markets) we’re seeing now into next year is the greatest seen since the Affordable Care Act was passed and implemented in the U.S. As member fluctuations and volatility continue, one thing’s for sure: having the most accurate data is crucial. Because different insurance segments have different coverage and network implications, it’s important to know where exactly the members are to target the right markets. By having up-to-date data, your organization will be best equipped to solve critical business problems and, ultimately, improve the care journey.


Subscribe to AIS Health’s Directory of Health Plans to get the most up-to-date health plan member data and trends to identify growth opportunities for your products.

0 Comments Industry Trends |
© 2024 MMIT
Erin Trompeter

Erin Trompeter

Erin Trompeter is the Manager of Payer Data at AIS Health, an MMIT company.

Related Posts

July 6

Helping Payers and Providers Grow Amid Volatility: Leveraging Data to Improve the Care Experience

Read More
October 5

What Does Member Disruption Mean to Payers?

Read More


Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today