HMA Insights: Your source for healthcare news, ideas and analysis.
HMA Insights – including our new podcast – puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.
With the planning and implementation of 988 and mobile crisis teams, as well as co-responder models, state policy makers are working rapidly to advance effective approaches to systemically and effectively address the needs of individuals and families who are experiencing behavioral health crises.
Central to effective implementation is attention to specific community needs. States are working to partner with local communities to build capacity, leverage the knowledge and expertise of local partners, and gain an understanding of how new benefits and system changes fit into existing community frameworks. This local approach is particularly important for rural and frontier communities, and for tailoring models to meet specific priority populations’ needs, while building trust and ensuring crisis services are grounded in equitable access and culturally responsive care.
With more than 25 years of crisis system development, HMA colleagues stand ready to support crisis system community partners in advancing their crisis systems and services.
With our finger on the pulse of the science-backed research and approaches necessary to create integrated and comprehensive systems, we can help identify barriers and explore and implement solutions.
Our HMA crisis system team supports community partners with:
Partnership development
Stakeholder engagement
Crisis system needs assessment – strengths and gaps analysis
Program design and implementation
Crisis service development
Cross-system protocols
Cost modeling and sustainable reimbursement approaches
Distilling and meeting regulations
For more information, contact our featured expert below.
On Tuesday, April 11, 2023, HMA hosted a Future Frame Conversation covering some of the changes outlined in the recent 2024 Medicare Advantage (MA) Rate Announcement. This cycle signals a new era for MA funding and risk adjustment. The Final Rate Announcement, in particular the new risk adjustment model to be phased in over three years, will spark stakeholders to reevaluate benefit design through the bid cycle and risk adjustment strategies in the future. These refinements will impact both health plan and provider reimbursement.
During the discussion:
Amy Bassano from HMA talked about the CMS strategy for these changes; and
Tim Murray from Wakely Consulting, an HMA company, discussed how payers should be using data and analytics to evaluate and forecast the impact of CMS changes.
Policy crossroads and the end of the public health emergency due to COVID-19
This is part of a three-part series on significant implications of the end of the Public Health Emergency (PHE).
The Biden administration has announced that the COVID-19 pandemic Public Health Emergency (PHE) declaration will expire on May 11, 2023. The end of the declaration and other changes in federal policy have significant implications for state Medicaid programs, including the end of a 6.2% increase in the regular federal medical assistance program (FMAP) matching rate for states and continuous enrollment requirements put into place early in the pandemic. This means that an estimated 4-14 million Americans, especially including women and children, will need to engage in state processes for re-certification to continue their Medicaid benefits and states will lose their enhanced matching.
While state have been planning for these changes, collectively referred to as “PHE Unwinding,” the public health implications of these shifts have received little attention. As millions of Americans lose Medicaid benefits, as a result of “PHE Unwinding,” public health departments nationwide are likely to face additional demands and pressures that are also critically important for states to consider. State public health agencies that have spent the last several years responding to the COVID-19 pandemic are now entering a new phase. During the CMS-recommended 12-month period that states have to complete their redeterminations, public health agencies may see increasing numbers of individuals who were previously eligible for Medicaid and other safety net services seeking access to public health programs. Public health officials also may be called on to address the community health impacts of the newly uninsured or those who have lost other benefits, such as enhanced Supplemental Nutrition Assistance Program (SNAP) dollars for food. Addressing challenges may require significant attention of Community Health Workers or other workforces engaged across public health and healthcare and take precedence over other public health priorities. All of this will be happening at a time when public health officials are being called on to re-imagine their infrastructure needs, including reconfiguring and modernizing their data systems.
Public health agencies planning for this immediate future may benefit by taking a systems approach to PHE unwinding and considering a few key variables in their planning—
1.The end of the PHE may rapidly increase demand for public health safety net programs.
Medicaid provides coverage for the sickest and most vulnerable. As redetermination processes leave some without insurance and other benefit programs like SNAP return to pre-pandemic coverage, historically marginalized and medically at-risk populations will be disproportionately impacted. This may result in increased demand for safety net programs usually found in public health departments that serve the under and uninsured, such as the Breast and Cervical Cancer Prevention Program (BCCP) that provides cancer screening for women, and Vaccines for Children (VFC) which provides required immunizations to school-age children who otherwise lack access. Programs such as the Women, Infants and Children (WIC) and perinatal home visiting programs that serve families with limited economic resources may also see increased numbers of eligible families. Health departments can quantify these increases by assessing their populations, estimating increases, and using their existing data to determine which communities and geographic areas are likely to exhibit the greatest needs, and then share this information with policymakers.
2.Unwinding may represent an opportunity to educate legislators and policymakers on the connection between Medicaid utilization and public health programs.
As states see decreases in federal matching for their Medicaid programs, policymakers will look for opportunities to fill gaps in the state share of operating these programs. Public health programs, which are usually run with a combination of state dollars and federal grants, are often looked at as potential sources to fill gaps in Medicaid program costs. Moreover, public health officials may be able to move upstream of these discussions by ensuring that states are maximizing the federal Medicaid match (FMAP) on any public health services that can be billed to Medicaid, including using waivers and state plan amendments to cover services such as maternal home visiting or tobacco cessation under Medicaid, thus stretching grant and state dollars further while covering more individuals. While public health has long discussed the benefits of calculating and sharing the long-term return on investment of public health services, officials may also wish to consider utilizing risk stratification strategies to identify short-term cost savings and cost avoidance to other state programs of the services offered by public health departments. At the local level, health departments are often closely involved in the delivery of services that keep children in school, adults at work, and protect people in hospitals and nursing homes from health care acquired infections. All of these services have immediate benefits to state and local economies.
3. New funding for public health infrastructure, data modernization, and workforce development represents an opportunity to drive collaboration between public health, Medicaid, and other sectors.
As a part of the American Rescue Plan, state public health agencies have received funding from CDC to strengthen their infrastructure to ensure that communities have the people, services, and systems to promote and protect public health. The grants are intended to allow states to focus on increasing the size and diversity of the public health workforce; modernize data systems; and ensure states can demonstrate the foundational capabilities of public health. CDC has affirmed its expectation that states will prioritize collaboration and organizational partnerships as part of these efforts. As state public health agencies use these federal investments to impact programs that reach priority populations and improve health outcomes, several opportunities to reach disadvantaged populations and improve their health outcomes become apparent. For example, public health agencies working collaboratively with state departments of education could lead to partnerships around school-based clinics or workforce training programs, while engaging with the private healthcare and laboratory sectors on data and disease surveillance seems promising. Health departments should start now to in preparation for the flurry of activity that will be sparked in the wake of the PHE. This might involve reaching out to potential partners or organizing town-hall-style” active listening sessions with citizens to meet people where they are and better understand the needs of the community they serve.
HMA and HMA companies will continue to analyze the public health implications of the Medicaid Unwinding and the end of the PHE. We have the depth and breadth of expertise to assist with capacity building, data collection and management, and population health analysis.
HMA can support your agency before or after the end of the PHE.
This week our In Focus section reviews the Florida Statewide Medicaid Managed Care Program (SMMC) Invitation to Negotiate (ITN), released on April 11, 2023, by the Florida Agency for Health Care Administration (AHCA). SMMC consists of three programs: Managed Medical Assistance (MMA), Long-term Care (LTC), and dental, covering 4.4 million individuals. This ITN is for contracts to provide MMA and LTC.
Under the SMMC program, all enrollees receive their services from a single plan providing managed medical assistance, long-term care, and specialty benefits. (Dental benefits are provided separately.)
AHCA will select plans that will achieve the agency’s goals, including providing healthy birth outcomes for mothers and their infants, improving childhood and adolescent mental health, maximizing home and community-based placement and services, and supporting the HOPE Florida program. HOPE Florida utilizes ‘Hope Navigators’ to help individuals achieve economic self-sufficiency, develop long term-goals, and map out a strategic plan by focusing on community collaboration between the private sector, faith-based community, nonprofits and government entities.
Additionally, with the new contracts, AHCA will implement the following changes:
Specialty plans will no longer be awarded separately but must be awarded to a comprehensive or MMA plan.
Enrolling voluntary recipients (such as individuals with intellectual or developmental disabilities) into the SMMC program and providing the opportunity for them to opt out
AHCA may mandatorily enroll into the MMA program full benefit dual-eligibles who are also in a Medicare Dual Eligible Special Needs Plan (DSNP).
AHCA will invite 10 plans to negotiate for awards as shown below:
Timeline
Proposals are due August 15, 2023, with an anticipated award date of December 11. Contract will run from October 1, 2024, through December 31, 2030. Contracts may not be renewed, but AHCA may extend the term to cover any delays during the transition to a new plan.
Evaluation
Plans can receive a total maximum number of points of 5,950. AHCA will invite top-ranking plans to negotiations to ensure that AHCA can enter into contracts with the minimum required number of plans per region.
Current Market
As of December 2022, Florida served 4.3 million MMA and LTC enrollees, excluding an additional 97,000 Children’s Medical Services enrollees in the Children’s Medical Services Network plan. Centene had the highest market share based on enrollment, at over 40 percent.
This week, our In Focus section reviews the recently announced major policy updates from the Centers for Medicare and Medicaid Services (CMS) that affect the Medicare Advantage (MA) and Part D programs.
First, on January 30, CMS released the final Risk Adjustment Data Validation Final Rule, a highly anticipated and controversial policy that establishes the agency’s approach to auditing MA Organizations’ (MAOs) risk-adjustment payments and collecting overpayments as needed. Second, CMS released the CY 2024 Advance Notice for MA Capitation Rates (Part C) and Part D Payment Policies on February 1, 2023. Read HMA’s summary of the advance notice.
Most recently, on March 31, 2023, CMS released the CY 2024 Final Rate Notice for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, which incorporates CMS’s responses to public comments on the Advance Notice. These changes reflect CMS’ continued efforts to strengthen oversight in the MA program, including improving payment accuracy, and implementation of Part D policies from the Inflation Reduction Act (IRA).
Below are highlights of some of the key provisions of the CY 2024 Final Rate Notice and significant changes CMS made from the Advance Notice to the Final Rate Notice.
Risk Adjustment: The Final Rate Notice details the updated risk adjustment model using restructured condition categories based on ICD-10 codes, newer data, and clinical adjustments made to ensure the conditions are stable predictors of costs in the model. Specifically, diagnoses data will come from 2018 rather than 2014 and expenditure data will come from 2019 rather than 2015 to reflect changes in costs. These updates should more accurately reflect the cost of caring for beneficiaries and make payments less susceptible to discretionary coding that can lead to excess payments to MA plans.
Also, CMS changed course from its initial proposal in the Advance Notice to implement the above risk adjustment model changes fully in 2024, and instead decided to phase in these changes over three years. The updated risk adjustment policy will be phased in over three years for organizations other than PACE. As a part of the agency’s phase-in plan, 67 percent of the CY 2024 risk adjustment will come from the risk scores measured under the 2020 adjustments and 33 percent will come from the 2024 adjustments. In CY 2025, 67 percent of the risk adjustment will come from the 2024 adjustment. In 2026, 100 percent of the risk adjustment will come from the 2024 adjustment. For PACE organizations in CY 2024, CMS will continue to use the 2017 risk adjustment model and associated frailty factors to calculate risk scores.
Effective Growth Rate: The effective growth rate identified within the Final Rate Notice for CY 2024 is 2.28%, up from 2.09% in the Advance Notice. The Effective Growth Rate is largely driven by growth in Medicare Fee-for-Service expenditures. CMS will phase in a technical adjustment to remove MA-related indirect medical education and direct graduate education costs from the historical and projected expenditures. The technical adjustment to the Effective Growth Rate will be phased in over three years, where 33 percent of the adjustment will apply in CY 2024, 67 percent in CY 2025, and 100 percent in CY 2026.
Payment rate impact in MA: CMS expects that average payments to MAOs will increase by 3.32 percent in CY 2024 because of the finalized rate announcement, which is higher than the 1.03 percent increase outlined in the Advance Notice. This will result in an estimated $13.8 billion increase in MA payments for CY 2024.
Medicare Part D: The changes from the Inflation Reduction Act to the Part D drug benefit will be implemented as described in the Advance Notice. The changes for CY 2024 include:
Elimination of cost sharing for covered Part D drugs for beneficiaries in the catastrophic phase of coverage.
Increased income limits from 135 percent of the federal poverty limit (FPL) to 150 percent of the FPL for the low-income subsidy program (LIS) under Part D for the full LIS benefit with a $0 deductible.
Continuation of the policy to not apply the deductible for any Part D covered insulin product. Also, in the initial coverage phase and the coverage gap phase, cost sharing must not exceed the applicable copayment amount, which for CY 2024 is $35 for a month’s supply of each covered insulin product.
Continuation of the policy not to apply the deductible to any adult vaccine recommended by the Advisory Committee on Immunization Practices (ACIP). Also, the statute requires these vaccines to be exempt from any co-insurance or other cost sharing, including cost sharing for vaccine administration and dispensing fees for such products, when administered in accordance with ACIP’s recommendation, for beneficiaries in the initial coverage and coverage gap phases.
Base beneficiary premium (BBP) growth will be held to no more than 6 percent by statute. The BBP for Part D in 2024 will be the lesser of the BBP for 2023 increased by 6 percent or the amount that would otherwise apply under the original methodology if the IRA were not enacted.
Star Ratings: Medicare Advantage star ratings for CY 2024 will include 30 measures with 12 included in the 2024 categorical adjustment index (CAI) values. By contrast, Part D star ratings for CY 2024 will include 12 measures with 5 of those measures included in the 2024 CAI values. The CAI for the 2024 Star Ratings is expected to be issued later in 2023. The CAI was introduced in 2017 as an interim analytical adjustment to address the average within-contract disparity in performance among beneficiaries who receive a low-income subsidy, are dual eligible, and/or are disabled.
The Final Rate Notice also includes three criteria for determining if Part C and D organizations are eligible for the “extreme and uncontrollable circumstances” adjustment to their Star Ratings. To be eligible, an organization must be in a 1) service area that is within the “emergency area” during the “emergency period,” 2) service area that is within a geographic area designated in a major disaster declaration under the Stafford Act and the Secretary exercised authority under the Act based on the same triggering events, and 3) a certain minimum percentage (25 or 60 percent) of beneficiaries must reside in the Federal Emergency Management Agency (FEMA) designated Individual Assistance area at the time of the extreme and uncontrollable circumstance. If an organization meets the criteria outlined and meets the 25 percent minimum, then they will receive the higher of their measure-level rating from the current and prior Star Ratings years for purposes of calculating the 2024 Star Ratings. For organizations meeting the 60 percent minimum and the other criteria, they are excluded from the measure-level cut point calculations for non-CAHPS measures, and the performance summary and variance thresholds.
Upcoming LinkedIn Live: Join HMA for our Future Frame Conversation on Policy Changes in Medicare Advantage and the Implications for Coding, Risk Adjustment, and Reimbursement. Tuesday April 11, 2023, at 12 p.m. E.T.
If you have questions about the contents of CMS’s MA final notice and how it will affect MA plans, providers, and patients, contact our featured experts below.
Health Management Associates (HMA) is a national leader in supporting states with the design, development, negotiation and implementation of Section 1115 demonstration waivers and waiver extensions. HMA has assisted more than 20 Medicaid departments directly with their state plan amendments, waivers, and other demonstration projects – and most recently supported Alaska, Colorado, Delaware, Indiana, Missouri, and Oklahoma.
HMA’s behavioral health team is currently working with multiple Medicaid agencies on the development of substance use disorder (SUD), serious mental illness (SMI), and serious emotional disturbance (SED) specific 1115 waivers.
We pair our behavioral health and Medicaid subject matter experts to support states with:
Developing and applying for SMI/SED and SUD Section 1115 demonstration waivers.
Providing an assessment of the requirements under the Section 1115 demonstration waiver and Medicaid managed care “in lieu of” authorities, including requirements for average length of stay, provider oversight, and monitoring, as well as other considerations.
Reviewing managed care contract requirements and providing applicable Medicaid managed care contract language for states that are utilizing “in lieu of” authority to provide reimbursement for inpatient or residential stays in IMDs.
Technical assistance with developing administrative infrastructure to monitor utilization, including adherence to length of stay requirements under the waiver and “in lieu of” options. CMS’ SMI Section 1115 demonstration waiver guidance prohibits states from receiving Federal Financial Participation (FFP) for any IMD stays that exceed 60 days. In cases where states do not meet this metric, CMS can reduce this maximum length of stay (LOS) to 45 days or less. HMA understands it is important for states to have utilization management (UM) strategies in place to identify these instances and minimize the state’s financial risk, and can therefore provide examples of state UM strategies, as well as incentives to manage inpatient and residential LOS while maintaining access to medically necessary services.
Supporting design of data capture and reporting functions for meeting wavier requirements.
Serving as the independent evaluator for approved SUD and/or SMI/SED 1115 waiver demonstrations.
For more information, contact our featured experts below.
Policy crossroads and the end of the public health emergency due to COVID-19
This is part of a three-part series on significant implications of the end of the Public Health Emergency (PHE).
What does your organization need to know?
March 31st marked the end of the COVID-19 Medicaid continuous coverage condition. Most forecasts project between 10-15 million enrollees will lose Medicaid coverage. State Medicaid programs will lose supplemental funding provided for the continuous coverage requirement and begin to transition to normal eligibility operations. Health Management Associates (HMA) and HMA companies can help the full spectrum of stakeholders plan for, adjust to, and administer the changes up to and beyond the 12-month continuous coverage “unwinding” period. The immediate work can serve as a springboard for future improvement initiatives and to respond to federal guidance that is under development to strengthen and streamline eligibility and enrollment processes and improve the experience for consumers.
Who is affected by this change?
Payers including Medicaid managed care organizations and Qualified Health Plans
Provider organizations
Trade associations of Medicaid managed care or provider organizations
State and local community-based organizations
State and local governments responsible for administering and overseeing the eligibility processes for Medicaid and other public programs
Advocacy groups
Foundations
Vendors supporting state agencies, health plans and providers
Watch a video presentation about the HMA Coverage Model
What is in the HMA model?
HMA has developed an insurance mix model that projects how the resumption of Medicaid eligibility redeterminations beginning in April 2023 will affect Medicaid enrollment, employer sponsored insurance (ESI), Marketplace coverage, and the uninsured. The model includes enrollment projections for all 50 states and considers the enhanced Marketplace subsidies included in the Inflation Reduction Act (IRA). Approximately 20 million individuals gained coverage during the redetermination freeze and well over 10 million of the approximately 90 million current Medicaid enrollees are at risk for disenrollment. HMA’s model contemplates the variety in state approaches to managing the resumption of eligibility redeterminations as well as key insights related to the differential impact by Medicaid eligibility categories.
HMA can help with immediate needs to help you plan:
HMA has detailed state-specific unwinding policy insights for each state including observations regarding which states are taking more aggressive and less aggressive approaches.
We can provide technical assistance and strategic planning services to help states and organizations manage the necessary changes.
Actuarial experts can assist with acuity changes caused by the change in enrollment.
Our colleagues are available for a discussion of the product and the key policies influencing the projections.
HMA can also help with post PHE support.
For more information, please contact our experts below.
This week our In Focus section reviews the Centers for Medicare and Medicaid Services’ (CMS) announcement of initial guidance for the new Medicare Drug Price Negotiation Program for 2026. This initial guidance is one of many steps CMS described in the Medicare Drug Price Negotiation Program timeline for the first year of negotiation.
The Drug Price Negotiation Program was approved as part of the Inflation Reduction Act (IRA) (P.L. 117- 169) in August 2022. As discussed in our previous In Focus, the IRA includes several other policies aimed at addressing cost, affordability and access to prescription drugs within the Medicare program.
The Drug Negotiation Program allows the U.S. Department of Health and Human Services (HHS) to negotiate maximum fair prices (MFPs) for Part D drugs. Negotiations between HHS and prescription drug manufactures will begin in 2023 and continue into 2024 before negotiated prices go into effect Jan. 1, 2026.
For Medicare payment in 2026, HHS can negotiate prices for up to 10 Part D drugs that do not have generic or biosimilar competition. CMS can increase the number of Part D drugs selected for price negotiation each subsequent year. Starting in 2028, the agency can annually add up to 20 new Part B or Part D drugs to the program.
The published guidance describes CMS’ approach for identifying the drugs selected for the initial year of the program. However, CMS is finalizing these policies as announced for the initial drug negotiation year.
The initial guidance also details the requirements and procedures for implementing the process for the first set of negotiations. For example, the guidance details aspects related to the offer-counter-offer exchange process, confidentiality terms following an agreement, penalties for violations, and the dispute resolution process.
Key Considerations
The drug negotiation program presents numerous operational and policy questions for CMS, manufacturers, and the healthcare sector broadly. The program is expected to have a direct impact on prices and affordability for the Medicare program and its beneficiaries. Additionally, other public and commercial payers will want to consider the potential downstream impacts on their costs. Ongoing monitoring of HHS’ implantation of the drug negotiation program and the pharmaceutical industry’s response to the drug negotiation program will help health plans, providers, and other interested stakeholders navigate this new landscape.
What’s Next
In the short-run, CMS will benefit from feedback from stakeholders about the outstanding policy and operational issues the agency has identified. Comments can be submitted until April 14, 2023
CMS anticipates issuing revised guidance for the first year of negotiation in Summer 2023. By September 1, 2023, CMS plans to publish the first 10 Part D drugs selected for the initial program year. The negotiated maximum fair prices for these drugs will be published by September 1, 2024 and prices will be in effect starting January 1, 2026.
HMA and HMA companies will continue to analyze this and subsequent guidance. We have analytical capabilities and expertise to assist with tailored analysis for manufacturers, providers, patient groups, health plans, and other stakeholders. HMA has the ability to model policy impacts of the drug negotiation program, support the drafting of feedback to CMS as the program is designed and implemented, and provide technical assistance in considering how this new program may interact with other Medicare and Medicaid initiatives.
If you have questions about the Drug Negotiation Program or other aspects of the Inflation Reduction Act and how it will affect manufacturers, Medicare providers, Medicaid programs and patients, contact our experts below.
On January 26, the Centers for Medicare & Medicaid Services (CMS) approved California’s (CA) section 1115 request to cover targeted healthcare services for incarcerated individuals 90 days before release. This historical partial rollback of the Medicaid Inmate Exclusion Policy empowers the CA Department of Health Care Services (DHCS) to collaborate with state agencies, counties, health plans and community-based organizations to create coordinated community reentry services focused on persons transitioning from incarceration to community that provide physical and behavioral healthcare services.
Fourteen states have pending section 1115 demonstration requests to provide specific healthcare services for justice-involved individuals. CMS has indicated it will be issuing guidance on the coverage parameters for healthcare services for individuals transitioning from carceral settings. These efforts allow states, counties, and cities to build coordinated systems of healthcare care to support reentry. Building such systems requires infrastructure development and enhancement, stakeholder engagement, strategic planning, and project and change management across justice partners, health plans, and community-based organizations.
Implementing the services will involve an in-depth understanding of the fundamental healthcare needs of justice-involved individuals, carceral setting healthcare delivery and reentry (transition to the community), and how to operationalize necessary changes to meet program requirements. Additionally, change management, critical stakeholder coordination, infrastructure, and technology development, enhancement, guidance on data-sharing agreements, and health plan involvement will need to be created or adapted to meet the CMS 1115 requirements. Administrators of carceral settings and correctional healthcare providers must coordinate services with community-based organizations and health plans to implement timely, cost-effective, and quality healthcare services to individuals leaving carceral facilities.
States, payors, correctional administrators, and healthcare providers will benefit from understanding the 1115 requirements to stand up this initiative, recommendations to facilitate the 1115 application process, how it intersects with healthcare delivery within a carceral setting and during reentry, and practical strategies for planning and operationalizing the effective delivery and coordination of healthcare services that meet program requirements.
On Thursday, April 6, 2023, HMA held a webinar to help states and other stakeholders understand the section 1115 parameters and provide insight to states, local government, correctional health settings, and providers on how to best plan for implementing such services.
Key experts covered the following topics:
Deep Dive into California’s section 1115 approval and lessons learned from the California application process?
Operationalizing In Reach and Re-entry Programming for Justice-Involved Individuals
Understanding the complex needs of justice-involved individuals.
What investments must states make to implement Medicaid-eligible services for justice-involved individuals?
What role can technology and digital health play in supplementing direct care?
The Role of Payers in new Services for Justice-Involved Individuals
See below for our HMA featured speakers.
HMA consultants bring unparalleled expertise in Medicaid policy, correctional health and a deep understanding of the unique needs of this population. We have the operational knowledge and experience with technology and digital health solutions, as well as the needed data and analytic capacity to collect the correct data to drive improvements in equity and access to care.
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 32 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 32 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2022. This report reflects the most recent data posted. HMA will continue tracking enrollment throughout the eligibility redetermination period. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
The 32 states in this report account for an estimated 71 million Medicaid managed care enrollees as of December 2022. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that nationwide Medicaid MCO enrollment was likely about 75 million in December 2022. As such, the enrollment data across these 32 states represents approximately 95 percent of all Medicaid MCO enrollment.
Across the 32 states tracked in this report, Medicaid managed care enrollment is up 7.5 percent year-over-year as of December 2022.
All states, besides Mississippi, saw increases in enrollment in December 2022, compared to the previous year, due to the gains from the COVID-19 pandemic. Mississippi Medicaid managed care enrollment fell because the state shifted members to FFS during the public health emergency.
Twenty-three of the 32 states – Arizona, California, District of Columbia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Virginia, Washington, and West Virginia – expanded Medicaid under the Affordable Care Act and have seen increased Medicaid managed care enrollment since expansion.
The 23 expansion states listed above have seen net Medicaid managed care enrollment increase by 3.5 million members, or 7.2 percent, in the past year, to 52.2 million members at the end of 2022.
The nine states that have not yet expanded Medicaid as of December 2022 – Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, and Wisconsin – have seen Medicaid managed care enrollment increase 8.3 percent to 19 million members at the end of 2022.
Table 1 – Monthly MCO Enrollment by State – July 2022 through December 2022
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Arizona
2,069,048
2,079,360
2,095,101
2,106,800
2,116,444
2,127,666
+/- m/m
8,527
10,312
15,741
11,699
9,644
11,222
% y/y
7.6%
0.0%
7.5%
7.4%
7.2%
7.1%
California
12,929,500
13,013,324
13,073,427
13,132,616
13,231,993
13,204,398
+/- m/m
215,506
83,824
60,103
59,189
99,377
(27,595)
% y/y
9.8%
9.9%
9.9%
9.9%
10.2%
9.5%
D.C.
246,957
247,704
248,577
249,617
250,676
+/- m/m
3,223
747
873
1,040
1,059
N/A
% y/y
6.7%
6.7%
6.5%
6.5%
6.4%
Florida
4,385,965
4,432,233
4,465,670
4,502,297
4,537,121
4,581,266
+/- m/m
41,441
46,268
33,437
36,627
34,824
44,145
% y/y
10.9%
10.9%
10.7%
10.7%
10.7%
11.0%
Georgia
1,975,277
1,988,727
2,016,462
2,027,275
2,035,673
+/- m/m
13,117
13,450
N/A
N/A
10,813
8,398
% y/y
9.8%
9.5%
9.0%
8.7%
8.3%
Illinois
2,890,332
2,884,029
2,900,232
2,929,584
2,965,007
3,000,717
+/- m/m
(8,672)
(6,303)
16,203
29,352
35,423
35,710
% y/y
5.1%
4.5%
4.1%
4.4%
5.1%
5.5%
Indiana
1,742,762
1,761,692
1,769,400
1,781,464
1,797,451
1,813,044
+/- m/m
6,906
18,930
7,708
12,064
15,987
15,593
% y/y
11.6%
11.3%
11.0%
10.5%
10.2%
10.3%
Iowa
795,534
799,748
807,296
812,481
814,490
+/- m/m
2,642
4,214
7,548
N/A
N/A
2,009
% y/y
5.9%
5.8%
6.4%
6.0%
6.1%
Kansas
489,309
490,911
492,640
497,257
499,143
500,814
+/- m/m
2,691
1,602
1,729
4,617
1,886
1,671
% y/y
N/A
N/A
N/A
N/A
8.3%
6.3%
Kentucky
1,494,068
1,487,387
1,509,274
1,518,906
1,528,484
1,534,657
+/- m/m
6,069
(6,681)
21,887
9,632
9,578
6,173
% y/y
5.5%
5.3%
5.6%
5.8%
6.7%
6.1%
Louisiana
1,821,644
1,828,015
1,833,457
1,841,693
1,858,092
1,860,170
+/- m/m
7,213
6,371
5,442
8,236
16,399
2,078
% y/y
4.6%
4.5%
4.4%
4.7%
5.2%
5.8%
Maryland
1,496,677
1,502,271
1,508,469
1,514,381
1,521,171
1,529,308
+/- m/m
8,205
5,594
6,198
5,912
6,790
8,137
% y/y
6.5%
6.2%
6.1%
5.8%
5.8%
5.7%
Michigan
2,280,243
2,294,432
2,299,913
2,309,913
2,319,951
2,324,046
+/- m/m
2,923
14,189
5,481
10,000
10,038
4,095
% y/y
3.8%
3.6%
3.5%
3.7%
4.5%
4.3%
Minnesota
1,261,112
1,262,073
1,278,954
1,286,890
1,293,858
1,299,194
+/- m/m
1,893
961
16,881
7,936
6,968
5,336
% y/y
7.3%
6.7%
7.4%
7.5%
7.5%
7.5%
Mississippi
367,137
363,387
364,612
355,694
367,902
396,880
+/- m/m
(452)
(3,750)
1,225
(8,918)
12,208
28,978
% y/y
-22.7%
-19.9%
-17.4%
-17.3%
-12.5%
-3.9%
Missouri
1,038,239
1,065,217
1,099,707
1,118,373
1,136,589
1,157,005
+/- m/m
26,520
26,978
34,490
18,666
18,216
20,416
% y/y
27.0%
29.1%
32.6%
31.7%
31.8%
29.0%
Nebraska
363,328
366,202
369,770
372,613
374,857
378,237
+/- m/m
2,740
2,874
3,568
2,843
2,244
3,380
% y/y
12.4%
11.9%
11.7%
11.2%
10.8%
10.6%
Nevada
687,362
689,139
697,752
675,465
685,736
692,890
+/- m/m
9,464
1,777
8,613
(22,287)
10,271
7,154
% y/y
9.3%
9.0%
9.3%
4.2%
5.2%
5.7%
New Jersey
2,100,947
2,113,930
2,125,181
2,130,868
2,144,514
2,158,966
+/- m/m
10,897
12,983
11,251
5,687
13,646
14,452
% y/y
7.4%
7.4%
7.2%
7.0%
7.1%
7.0%
New Mexico
809,991
811,732
812,995
813,630
814,466
815,798
+/- m/m
2,491
1,741
1,263
635
836
1,332
% y/y
4.2%
3.7%
3.4%
3.0%
2.6%
2.3%
New York
5,855,615
5,853,108
5,878,519
5,906,264
5,929,288
5,961,782
+/- m/m
39,970
(2,507)
25,411
27,745
23,024
32,494
% y/y
4.5%
4.3%
4.2%
4.3%
4.5%
4.6%
North Carolina
1,738,545
1,746,948
1,757,503
1,768,974
1,778,199
1,837,423
+/- m/m
9,047
8,403
10,555
11,471
9,225
59,224
% y/y
8.0%
6.8%
6.7%
6.6%
6.6%
9.5%
Ohio
2,964,731
2,963,616
2,960,922
2,958,666
2,961,983
2,973,763
+/- m/m
(1,340)
(1,115)
(2,694)
(2,256)
3,317
11,780
% y/y
3.4%
2.6%
1.9%
1.4%
1.0%
0.9%
Oregon
1,193,358
1,202,198
1,206,520
1,211,099
1,221,435
1,228,054
+/- m/m
3,920
8,840
4,322
4,579
10,336
6,619
% y/y
8.3%
8.4%
7.7%
7.6%
7.4%
7.2%
Pennsylvania
2,895,837
2,909,985
2,920,584
2,937,049
2,950,613
2,966,207
+/- m/m
13,973
14,148
10,599
16,465
13,564
15,594
% y/y
7.4%
7.3%
6.9%
6.8%
6.6%
6.5%
South Carolina
1,055,785
1,063,445
1,069,569
1,078,094
1,084,529
1,089,577
+/- m/m
5,226
7,660
6,124
8,525
6,435
5,048
% y/y
7.6%
7.5%
7.4%
7.9%
7.6%
7.5%
Tennessee
1,692,395
1,704,398
1,710,125
1,718,539
1,726,603
1,734,108
+/- m/m
6,737
12,003
5,727
8,414
8,064
7,505
% y/y
6.0%
6.1%
6.1%
6.0%
5.9%
5.8%
Texas
5,466,045
5,653,169
+/- m/m
N/A
N/A
N/A
N/A
N/A
N/A
% y/y
8.6%
10.6%
Virginia
1,572,923
1,582,973
1,589,722
1,598,875
1,608,840
1,619,311
+/- m/m
11,829
10,050
6,749
9,153
9,965
10,471
% y/y
11.3%
11.0%
10.0%
9.6%
10.1%
9.8%
Washington
1,884,734
1,898,983
1,904,127
1,913,230
1,927,690
1,959,278
+/- m/m
8,867
14,249
5,144
9,103
14,460
31,588
% y/y
#DIV/0!
#DIV/0!
5.8%
5.9%
6.0%
7.2%
West Virginia
519,992
524,042
524,922
527,226
530,494
533,194
+/- m/m
2,871
4,050
880
2,304
3,268
2,700
% y/y
6.5%
6.8%
6.4%
5.9%
5.9%
5.7%
Wisconsin
1,161,202
1,166,208
1,172,719
1,179,204
1,184,899
1,190,673
+/- m/m
5,263
5,006
6,511
6,485
5,695
5,774
% y/y
7.5%
7.2%
7.1%
7.1%
6.9%
6.6%
Note: In Table 1 above and the state tables below, “+/- m/m” refers to the enrollment change from the previous month. “% y/y” refers to the percentage change in enrollment from the same month in the previous year.
Below, we provide a state-specific analysis of recent enrollment trends in the states where HMA tracks data.
It is important to note the limitations of the data presented. First, not all states report the data at the same time during the month. Some of these figures reflect beginning-of-the-month totals, while others reflect an end-of-the-month snapshot. Second, in some cases the data is comprehensive in that it covers all state-sponsored health programs for which the state offers managed care; in other cases, the data reflects only a subset of the broader Medicaid managed care population. This is the key limiting factor in comparing the data described below and figures reported by publicly traded Medicaid MCOs. Consequently, the data we review in Table 1 and throughout the In Focus section should be viewed as a sampling of enrollment trends across these states rather than a comprehensive comparison, which cannot be developed based on publicly available monthly enrollment data.
State-Specific Analysis
Arizona
Medicaid Expansion Status: Expanded January 1, 2014
Enrollment in Arizona’s two Medicaid managed care programs grew to 2.1 million in December 2022, up 7.1 percent from December 2021.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Acute Care
2,002,584
2,012,802
2,028,335
2,039,880
2,049,311
2,060,376
ALTCS
66,464
66,558
66,766
66,920
67,133
67,290
Total Arizona
2,069,048
2,079,360
2,095,101
2,106,800
2,116,444
2,127,666
+/- m/m
8,527
10,312
15,741
11,699
9,644
11,222
% y/y
7.6%
7.5%
7.4%
7.2%
7.1%
California
Medicaid Expansion Status: Expanded January 1, 2014
Medi-Cal managed care enrollment was up 9.5 percent year-over-year to 13.2 million, as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Two-Plan Counties
8,356,137
8,409,817
8,446,514
8,481,885
8,548,096
8,588,418
Imperial/San Benito
100,384
101,117
101,633
102,064
102,881
103,437
Regional Model
364,066
366,437
368,624
370,361
373,402
375,473
GMC Counties
1,435,250
1,445,532
1,452,127
1,458,149
1,470,122
1,391,421
COHS Counties
2,561,831
2,578,747
2,593,003
2,608,731
2,625,795
2,634,112
Duals Demonstration
111,832
111,674
111,526
111,426
111,697
111,537
Total California
12,929,500
13,013,324
13,073,427
13,132,616
13,231,993
13,204,398
+/- m/m
215,506
83,824
60,103
59,189
99,377
(27,595)
% y/y
9.8%
9.9%
9.9%
9.9%
10.2%
9.5%
District of Columbia
Medicaid Expansion Status: Expanded January 1, 2014
Medicaid managed care enrollment in the District of Columbia was up 6.4 percent to almost 251,000 in November 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Total District of Columbia
246,957
247,704
248,577
249,617
250,676
+/- m/m
3,223
747
873
1,040
1,059
% y/y
6.7%
6.7%
6.5%
6.5%
6.4%
Florida
Medicaid Expansion Status: Not Expanded
Florida’s statewide Medicaid managed care program had seen an 11 percent rise in total covered lives over the last year to nearly 4.6 million beneficiaries as of December 2022. (Note that the managed LTC enrollment figures listed below are a subset of the Managed Medical Assistance (MMA) enrollments and are included in the MMA number; they are not separately added to the total to avoid double counting).
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
MMA
3,908,539
3,948,929
3,978,098
4,010,534
4,041,816
4,080,381
LTC (Subset of MMA)
124,107
124,691
125,397
126,144
126,720
126,621
SMMC Specialty Plan
332,179
338,057
342,325
346,516
350,058
355,638
FL Healthy Kids
145,247
145,247
145,247
145,247
145,247
145,247
Total Florida
4,385,965
4,432,233
4,465,670
4,502,297
4,537,121
4,581,266
+/- m/m
41,441
46,268
33,437
36,627
34,824
44,145
% y/y
10.9%
10.9%
10.7%
10.7%
10.7%
11.0%
Georgia
Medicaid Expansion Status: Not Expanded
As of December 2022, Georgia’s Medicaid managed care program covered more than 2 million members, up 8.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Georgia
1,975,277
1,988,727
2,016,462
2,027,275
2,035,673
+/- m/m
13,117
13,450
10,813
8,398
% y/y
9.8%
9.5%
9.0%
8.7%
8.3%
Illinois
Medicaid Expansion Status: Expanded January 1, 2014
Illinois enrollment across the state’s managed care programs was up 5.5 percent to 3 million as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
HealthChoice
2,800,420
2,793,124
2,809,689
2,839,342
2,874,700
2,909,303
Duals Demonstration
89,912
90,905
90,543
90,242
90,307
91,414
Total Illinois
2,890,332
2,884,029
2,900,232
2,929,584
2,965,007
3,000,717
+/- m/m
(8,672)
(6,303)
16,203
29,352
35,423
35,710
% y/y
5.1%
4.5%
4.1%
4.4%
5.1%
5.5%
Indiana
Medicaid Expansion Status: Expanded in 2015 through HIP 2.0
As of December 2022, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—was more than 1.8 million, up 10.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Hoosier Healthwise
845,910
852,904
857,952
863,973
869,613
876,606
Hoosier Care Connect
102,805
102,819
102,537
102,253
102,200
102,150
HIP
794,047
805,969
808,911
815,238
825,638
834,288
Indiana Total
1,742,762
1,761,692
1,769,400
1,781,464
1,797,451
1,813,044
+/- m/m
6,906
18,930
7,708
12,064
15,987
15,593
% y/y
11.6%
11.3%
11.0%
10.5%
10.2%
10.3%
Iowa
Medicaid Expansion Status: Expanded January 1, 2014
Iowa launched its statewide Medicaid managed care program in April of 2016. Enrollment across all populations was nearly 814,500, as of December 2022. Enrollment was up 6.1 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Traditional Medicaid
507,266
510,618
516,556
520,234
521,118
Iowa Wellness Plan
237,910
239,261
242,555
244,724
246,385
hawk-i
50,358
49,869
48,185
47,523
46,987
Total Iowa
795,534
799,748
807,296
812,481
814,490
+/- m/m
2,642
4,214
7,548
2,009
% y/y
5.9%
5.8%
6.4%
6.0%
6.1%
Kansas
Medicaid Expansion Status: Not Expanded
Kansas Medicaid managed care enrollment was nearly 501,000 as of December 2022, up 6.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Kansas
489,309
490,911
492,640
497,257
499,143
500,814
+/- m/m
2,691
1,602
1,729
4,617
1,886
1,671
% y/y
8.3%
6.3%
Kentucky
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, Kentucky covered more than 1.5 million beneficiaries in risk-based managed care. Total enrollment was up 6.1 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Kentucky
1,494,068
1,487,387
1,509,274
1,518,906
1,528,484
1,534,657
+/- m/m
6,069
(6,681)
21,887
9,632
9,578
6,173
% y/y
5.5%
5.3%
5.6%
5.8%
6.7%
6.1%
Louisiana
Medicaid Expansion Status: Expanded July 1, 2016
Medicaid managed care enrollment in Louisiana was more than 1.86 million as of December 2022, up 5.8 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Louisiana
1,821,644
1,828,015
1,833,457
1,841,693
1,858,092
1,860,170
+/- m/m
7,213
6,371
5,442
8,236
16,399
2,078
% y/y
4.6%
4.5%
4.4%
4.7%
5.2%
5.8%
Maryland
Medicaid Expansion Status: Expanded January 1, 2014
Maryland’s Medicaid managed care program covered more than 1.5 million lives as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Maryland
1,496,677
1,502,271
1,508,469
1,514,381
1,521,171
1,529,308
+/- m/m
8,205
5,594
6,198
5,912
6,790
8,137
% y/y
6.5%
6.2%
6.1%
5.8%
5.8%
5.7%
Michigan
Medicaid Expansion Status: Expanded April 1, 2014
As of December 2022, Michigan’s Medicaid managed care was up 4.3 percent to 2.3 million.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Medicaid
2,239,937
2,251,810
2,256,800
2,265,219
2,274,763
2,279,473
MI Health Link (Duals)
40,306
42,622
43,113
44,694
45,188
44,573
Total Michigan
2,280,243
2,294,432
2,299,913
2,309,913
2,319,951
2,324,046
+/- m/m
2,923
14,189
5,481
10,000
10,038
4,095
% y/y
3.8%
3.6%
3.5%
3.7%
4.5%
4.3%
Minnesota
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, enrollment across Minnesota’s multiple managed Medicaid programs was nearly 1.3 million, up 7.5 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Parents/Kids
748,197
748,513
758,100
763,044
767,798
770,918
Expansion Adults
272,666
273,387
278,421
281,284
284,073
288,680
Senior Care Plus
24,190
24,252
25,344
25,914
26,415
26,740
Senior Health Options
43,429
43,686
43,920
44,162
44,248
44,324
Special Needs BasicCare
64,656
64,484
65,562
65,763
65,987
66,171
Moving Home Minnesota
11
11
10
10
9
11
Minnesota Care
107,963
107,740
107,597
106,713
105,328
102,350
Total Minnesota
1,261,112
1,262,073
1,278,954
1,286,890
1,293,858
1,299,194
+/- m/m
1,893
961
16,881
7,936
6,968
5,336
% y/y
7.3%
6.7%
7.4%
7.5%
7.5%
7.5%
Mississippi
Medicaid Expansion Status: Not Expanded
MississippiCAN, the state’s Medicaid managed care program, had membership down 3.9 percent to nearly 397,000 as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Mississippi
367,137
363,387
364,612
355,694
367,902
396,880
+/- m/m
(452)
(3,750)
1,225
(8,918)
12,208
28,978
% y/y
-22.7%
-19.9%
-17.4%
-17.3%
-12.5%
-3.9%
Missouri
Medicaid Expansion Status: Expansion Enrollment began in October 2021
Missouri managed care enrollment in the Medicaid and CHIP programs was nearly 1.2 million in December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Medicaid
758,928
757,312
769,419
775,076
782,863
787,611
Total CHIP
28,949
28,937
29,026
29,121
29,231
29,402
Total AEG
199,963
228,361
250,131
262,612
272,574
287,692
Total SHK
50,399
50,607
51,131
51,564
51,921
52,300
Total Missouri
1,038,239
1,065,217
1,099,707
1,118,373
1,136,589
1,157,005
+/- m/m
26,520
26,978
34,490
18,666
18,216
20,416
% y/y
27.0%
29.1%
32.6%
31.7%
31.8%
29.0%
Nebraska
Medicaid Expansion Status: Expanded October 1, 2020
As of December 2022, Nebraska’s Medicaid managed care program enrolled 378,000 members, up 10.6 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Nebraska
363,328
366,202
369,770
372,613
374,857
378,237
+/- m/m
2,740
2,874
3,568
2,843
2,244
3,380
% y/y
12.4%
11.9%
11.7%
11.2%
10.8%
10.6%
Nevada
Medicaid Expansion Status: Expanded January 1, 2014
Nevada’s Medicaid managed care enrollment was up 5.7 percent to nearly 693,000 as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Nevada
687,362
689,139
697,752
675,465
685,736
692,890
+/- m/m
9,464
1,777
8,613
(22,287)
10,271
7,154
% y/y
9.3%
9.0%
9.3%
4.2%
5.2%
5.7%
New Jersey
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, New Jersey Medicaid managed care enrollment was up 7 percent to nearly 2.2 million.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total New Jersey
2,100,947
2,113,930
2,125,181
2,130,868
2,144,514
2,158,966
+/- m/m
10,897
12,983
11,251
5,687
13,646
14,452
% y/y
7.4%
7.4%
7.2%
7.0%
7.1%
7.0%
New Mexico
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, New Mexico’s Centennial Care program covered nearly 816,000 members, up 2.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total New Mexico
809,991
811,732
812,995
813,630
814,466
815,798
+/- m/m
2,491
1,741
1,263
635
836
1,332
% y/y
4.2%
3.7%
3.4%
3.0%
2.6%
2.3%
New York
Medicaid Expansion Status: Expanded January 1, 2014
New York’s Medicaid managed care programs collectively covered nearly 6 million beneficiaries as of December 2022, a 4.6 percent increase from the previous year. The Medicaid Advantage program ended in December 2021.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Mainstream MCOs
5,399,089
5,395,489
5,418,915
5,446,409
5,467,467
5,494,358
Managed LTC
255,999
256,538
258,236
257,360
260,087
264,965
Medicaid Advantage
0
0
0
0
0
0
Medicaid Advantage Plus
34,357
34,355
34,689
34,764
34,717
35,061
HARP
164,514
165,067
165,024
166,063
165,340
165,713
FIDA-IDD (Duals)
1,656
1,659
1,655
1,668
1,677
1,685
Total New York
5,855,615
5,853,108
5,878,519
5,906,264
5,929,288
5,961,782
+/- m/m
39,970
(2,507)
25,411
27,745
23,024
32,494
% y/y
4.5%
4.3%
4.2%
4.3%
4.5%
4.6%
North Carolina
Medicaid Expansion Status: Not Expanded
As of December 2022, enrollment in North Carolina’s Medicaid managed care program was 1.8 million, up 9.5 percent from the prior year. North Carolina implemented Medicaid managed care on July 1, 2021.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total North Carolina
1,738,545
1,746,948
1,757,503
1,768,974
1,778,199
1,837,423
+/- m/m
9,047
8,403
10,555
11,471
9,225
59,224
% y/y
8.0%
6.8%
6.7%
6.6%
6.6%
9.5%
Ohio
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, enrollment across all four Ohio Medicaid managed care programs was nearly 3 million, up 0.9 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
CFC Program
1,800,781
1,800,038
1,798,135
1,796,327
1,798,873
1,804,860
ABD/Duals
348,071
348,176
347,461
347,371
347,473
347,839
Group 8 (Expansion)
815,879
815,402
815,326
814,968
815,637
821,064
Total Ohio
2,964,731
2,963,616
2,960,922
2,958,666
2,961,983
2,973,763
+/- m/m
(1,340)
(1,115)
(2,694)
(2,256)
3,317
11,780
% y/y
3.4%
2.6%
1.9%
1.4%
1.0%
0.9%
Oregon
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program was more than 1.2 million, up 7.2 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Oregon
1,193,358
1,202,198
1,206,520
1,211,099
1,221,435
1,228,054
+/- m/m
3,920
8,840
4,322
4,579
10,336
6,619
% y/y
8.3%
8.4%
7.7%
7.6%
7.4%
7.2%
Pennsylvania
Medicaid Expansion Status: Expanded January 1, 2015
As of December 2022, Pennsylvania’s Medicaid managed care enrollment was nearly 3 million, up 6.5 percent in the past year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Pennsylvania
2,895,837
2,909,985
2,920,584
2,937,049
2,950,613
2,966,207
+/- m/m
13,973
14,148
10,599
16,465
13,564
15,594
% y/y
7.4%
7.3%
6.9%
6.8%
6.6%
6.5%
South Carolina
Medicaid Expansion Status: Not Expanded
South Carolina’s Medicaid managed care programs collectively enrolled nearly 1.1 million members as of December 2022, which represents an increase of 7.5 percent in the past year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Medicaid
1,041,909
1,049,706
1,056,026
1,064,548
1,071,016
1,076,146
Total Duals Demo
13,876
13,739
13,543
13,546
13,513
13,431
Total South Carolina
1,055,785
1,063,445
1,069,569
1,078,094
1,084,529
1,089,577
+/- m/m
5,226
7,660
6,124
8,525
6,435
5,048
% y/y
7.6%
7.5%
7.4%
7.9%
7.6%
7.5%
Tennessee
Medicaid Expansion Status: Not Expanded
As of December 2022, TennCare managed care enrollment totaled 1.7 million, up 5.8 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Tennessee
1,692,395
1,704,398
1,710,125
1,718,539
1,726,603
1,734,108
+/- m/m
6,737
12,003
5,727
8,414
8,064
7,505
% y/y
6.0%
6.1%
6.1%
6.0%
5.9%
5.8%
Texas
Medicaid Expansion Status: Not Expanded
Texas’ state fiscal year begins in September and program-specific enrollment is only reported at the end of each state fiscal quarter. As of November 2022, Texas Medicaid managed care enrollment was nearly 5.7 million across the state’s six managed care programs, up 10.6 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
STAR
4,559,293
4,748,820
STAR+PLUS
559,746
568,456
STAR HEALTH
45,760
46,228
Duals Demo
34,336
33,673
CHIP
97,153
85,773
STAR KIDS
169,757
170,219
Total Texas
5,466,045
5,653,169
+/- m/m
% y/y
8.6%
10.6%
Virginia
Medicaid Expansion Status: January 1, 2019
Virginia Medicaid managed care enrollment was up 9.8 percent in December 2022 to 1.6 million members.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Virginia
1,572,923
1,582,973
1,589,722
1,598,875
1,608,840
1,619,311
+/- m/m
11,829
10,050
6,749
9,153
9,965
10,471
% y/y
11.3%
11.0%
10.0%
9.6%
10.1%
9.8%
Washington
Medicaid Expansion Status: Expanded January 1, 2014
Washington’s Medicaid managed care enrollment increased 7.2 percent to nearly 2 million as of December 2022, compared to the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Washington
1,884,734
1,898,983
1,904,127
1,913,230
1,927,690
1,959,278
+/- m/m
8,867
14,249
5,144
9,103
14,460
31,588
% y/y
#DIV/0!
#DIV/0!
5.8%
5.9%
6.0%
7.2%
West Virginia
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, West Virginia’s Medicaid managed care program covered 533,000 members, up 5.7 percent year-over-year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total West Virginia
519,992
524,042
524,922
527,226
530,494
533,194
+/- m/m
2,871
4,050
880
2,304
3,268
2,700
% y/y
6.5%
6.8%
6.4%
5.9%
5.9%
5.7%
Wisconsin
Medicaid Expansion Status: Not Expanded
Across Wisconsin’s three Medicaid managed care programs, December 2022 enrollment totaled nearly 1.2 million, up 6.6 percent from the year before.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
BadgerCare+
1,042,456
1,047,217
1,053,361
1,059,587
1,065,182
1,070,788
SSI
61,841
61,916
62,065
62,129
62,165
62,293
LTC
56,905
57,075
57,293
57,488
57,552
57,592
Total Wisconsin
1,161,202
1,166,208
1,172,719
1,179,204
1,184,899
1,190,673
+/- m/m
5,263
5,006
6,511
6,485
5,695
5,774
% y/y
7.5%
7.2%
7.1%
7.1%
6.9%
6.6%
More Information Available from HMA Information Services
More detailed information on the Medicaid managed care landscape is available from HMA Information Services (HMAIS), which collects Medicaid enrollment data, health plan financials, and the latest on expansions, waivers, duals, ABD populations, long-term care, accountable care organizations, and patient-centered medical homes. HMAIS also includes a public documents library with copies of Medicaid RFPs, responses, model contracts, and scoring sheets.
HMAIS enhances this publicly available information with an overview of the structure of Medicaid in each state, as well as proprietary Medicaid Managed Care RFP calendars.
[1] Arizona, California, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin.
This week, our In Focus section highlights a Wakely, an HMA Company, summary and analysis of the 2024 Medicare Advantage Advance Notice, prepared for America’s Health Insurance Plans (AHIP). The Centers for Medicare & Medicaid Services (CMS) released the contract year (CY) 2024 Advance Notice with an accompanying fact sheet on February 1, 2023. AHIP has retained Wakely Consulting Group to provide a financial impact summary report of the information presented in the notice. Specifically, Wakely was asked to analyze changes to Medicare Advantage (MA) revenue, risk adjustment models, and fee-for-service (FFS) normalization.
Key highlights of the analysis are:
The CY 2024 FFS growth rate is lower than projections from the 2023 Final Announcement. A portion of the downward restatement is driven by a technical change. CMS has not commented on the additional drivers.
Based on a large sample of plans, Wakely estimated that the proposed Part C risk adjustment model is expected to decrease plan risk adjusted payment by 3.7 percent overall, which represents a bigger headwind than the CMS estimated decrease of 3.12 percent. The impacts vary significantly by model segment and geographic region, and for individual plans.
The proposed FFS normalization factor excludes PY 2021 risk scores in the calculation of the underlying trend. The exclusion of PY 2021 increases the FFS normalization factor which decreases PY 2024 risk scores.
The report, released March 6, 2023, provides additional detail and discussion of these issues. For questions, please contact our experts below.
This week, our In Focus reviews a new Health Management Associates (HMA) report, highlighting hybrid (in-person & virtual visits) as the future of child welfare service delivery. During the COVID-19 public health emergency (PHE), the federal government waived the requirement for “once every 30 days” in-person visits by caseworkers for children in foster care, allowing these visits to occur virtually. In 2021, Casey Family Programs (CFP) commissioned HMA to evaluate the delivery of virtual child welfare services and outline the implications of the COVID-19 PHE on the child welfare system.
The report “Evaluating the Delivery of Virtual Child Welfare Services” is now available. It summarizes HMA’s findings and elevates the voices of staff in public and private child welfare agencies, and of youth and families with lived experiences, and examines their perspectives on how well virtual services have worked. It also details the implications of the COVID-19 PHE, the response from public child welfare agencies, and offers guidance on a hybrid (part in-person, part virtual) service model, which we believe will continue to be a factor in the future delivery of child welfare services.
As the COVID-19 PHE accelerated the spread and scale of telehealth adoption in health care, we surmised that the experience offered valuable opportunities to learn more about how the health care sector’s adoption of telehealth services could be applied in the child welfare community. While cognizant of the unique considerations for child welfare, this disruption also represents a substantial opportunity to rethink the child welfare system and advance both the use of technology as well as a more prevention- and strengths-based approach to child welfare.
The report highlights innovative approaches in the field, offers questions to frame a jurisdiction’s decision-making process, and provides a tool to facilitate an informed decision on the hybrid model. The report also offers a broader value proposition that outlines policy, practice, workforce, and technology imperatives to develop a hybrid approach to the delivery of child welfare services.
