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Medicaid Managed Care Enrollment Update – Q2 2018

This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 28 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. Nearly all 28 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2018. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):

  • Eighteen of the 28 states– Arizona, California, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Pennsylvania, Washington, and West Virginia – expanded Medicaid under the Affordable Care Act and have seen increased Medicaid managed care enrollment as a result of expansion.
  • The 28 states in this report account for an estimated 48.5 million Medicaid managed care enrollees as of the end of Q2 2018. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that, nationwide, Medicaid MCO enrollment is has likely surpassed 54 million in the second half of 2018. As such, the enrollment data across these 28 states represents nearly 90 percent of all Medicaid MCO enrollment.
  • States with managed care that do not publish monthly enrollment reports are Delaware, District of Columbia, Massachusetts, New Hampshire, New Jersey, Nevada, Rhode Island, Utah, and Virginia.
  • Across the 28 states tracked in this report, Medicaid managed care enrollment is down 1.8 percent year-over-year as of June 2018, losing 902,000 enrollees since June 2017.
  • The 18 expansion states listed above have seen net Medicaid managed care enrollment decrease by 1.2 million members, or 3.2 percent, in the past year, to 35.2 million members at the end of Q2 2018.
  • The ten states that have not yet expanded Medicaid have seen net Medicaid managed care enrollment increase by roughly 261,000 members, or 2 percent, to 13.3 million members at the end of Q2 2018.

Table 1 – Monthly MCO Enrollment by State – January 2018 through June 2018

  Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Arizona 1,593,731 1,564,685 1,551,310 1,558,234 1,556,733 1,556,030
+/- m/m (10,477) (29,046) (13,375) 6,924 (1,501) (703)
% y/y -1.3% -3.3% -4.1% -3.6% -4.0% -4.0%
California 10,718,352 10,766,203 10,766,119 10,747,826 10,742,697 10,715,384
+/- m/m (101,217) 47,851 (84) (18,293) (5,129) (27,313)
% y/y -0.3% -0.4% -0.7% -0.9% -1.0% -1.1%
Florida 3,279,797 3,277,087 3,256,758 3,249,656 3,206,443 3,199,319
+/- m/m (9,493) (2,710) (20,329) (7,102) (43,213) (7,124)
% y/y -3.8% -3.7% -4.2% -3.9% -5.4% -5.1%
Georgia 1,385,309 1,364,013 1,371,031 1,376,894 1,381,729 1,388,318
+/- m/m 18,843 (21,296) 7,018 5,863 4,835 6,589
% y/y 6.9% 0.0% 0.0% 0.0% 0.0% 7.4%
Hawaii            
+/- m/m N/A N/A N/A N/A N/A N/A
% y/y
Illinois 1,958,963 1,845,437 1,779,439 2,304,309 2,281,761  
+/- m/m 0 (113,526) (65,998) 524,870 (22,548) N/A
% y/y 0.0% -6.2% -10.3% 17.0% 17.0%
Indiana 1,163,060 1,160,063 1,154,916 1,150,027 1,139,644  
+/- m/m 450 (2,997) (5,147) (4,889) (10,383) N/A
% y/y 3.4% 0.0% 0.9% 1.0% 0.0%
Iowa 589,476 594,206 609,436 614,770 615,117 616,240
+/- m/m 5,356 4,730 15,230 5,334 347 1,123
% y/y -4.7% -3.8% -1.2% 0.0% 0.3% 0.8%
Kansas 389,982 394,084 395,134 391,496 388,086  
+/- m/m N/A 4,102 1,050 (3,638) (3,410) N/A
% y/y N/A N/A N/A N/A N/A
Kentucky 1,253,720 1,260,100        
+/- m/m (2,181) 6,380 N/A N/A N/A N/A
% y/y -1.7% -1.1%
Louisiana 1,478,796 1,482,039 1,479,366 1,482,238 1,473,685  
+/- m/m 1,747 3,243 (2,673) 2,872 (8,553) N/A
% y/y 3.4% 2.1% 0.9% 1.4% 0.4%
Maryland 1,184,988 1,190,909 1,200,835 1,199,471 1,185,607  
+/- m/m 11,181 5,921 9,926 (1,364) (13,864) N/A
% y/y 3.9% 3.6% 3.1% 2.5% 1.7%
Michigan 1,820,682 1,790,355 1,751,591 1,758,356 1,819,990 1,820,205
+/- m/m 3,284 (30,327) (38,764) 6,765 61,634 215
% y/y 1.5% -0.5% -3.5% -4.7% -1.4% -1.3%
Minnesota 923,351 938,001 949,740 965,963 972,059 981,982
+/- m/m (34,933) 14,650 11,739 16,223 6,096 9,923
% y/y 5.1% 4.8% 4.8% 4.6% 6.7% 6.6%
Mississippi 470,595 465,017 457,903 454,495 451,931 447,263
+/- m/m (5,571) (5,578) (7,114) (3,408) (2,564) (4,668)
% y/y -4.2% -5.0% -6.3% -7.1% -7.3% -8.6%
Missouri 717,132 715,812 709,809 710,931 713,930 712,335
+/- m/m 2,011 (1,320) (6,003) 1,122 2,999 (1,595)
% y/y 41.7% 42.6% 41.4% 42.0% -3.8% -2.8%
Nebraska         233,723  
+/- m/m N/A N/A N/A N/A N/A N/A
% y/y N/A
New Mexico 668,600 668,531 669,705 669,934 665,680 660,918
+/- m/m 3,775 (69) 1,174 229 (4,254) (4,762)
% y/y -3.7% -4.2% -4.4% -4.1% -4.3% -4.6%
New York 4,689,794 4,721,439 4,767,511 4,763,276 4,765,574 4,763,395
+/- m/m (25,897) 31,645 46,072 (4,235) 2,298 (2,179)
% y/y 1.2% 1.8% 2.3% 2.1% 1.8% 1.4%
Ohio 2,491,148 2,490,175 2,488,643 2,398,185 2,473,647 2,449,971
+/- m/m 6,280 (973) (1,532) (90,458) 75,462 (23,676)
% y/y -0.3% -1.1% -1.5% -5.6% 5.1% -4.1%
Oregon 889,085 888,202 895,525      
+/- m/m NA (883) 7,323 N/A N/A N/A
% y/y -0.7% -0.5% 2.8%
Pennsylvania 2,323,090 2,331,485 2,334,009      
+/- m/m 8,484 8,395 2,524 N/A N/A N/A
% y/y 2.2% 1.9% 1.6%
South Carolina         792,224 757,362
+/- m/m N/A N/A N/A N/A 0 (34,862)
% y/y 2.3% -2.3%
Tennessee 1,476,052 1,452,485 1,446,478 1,431,487 1,415,526 1,418,407
+/- m/m 13,112 (23,567) (6,007) (14,991) (15,961) 2,881
% y/y -4.3% -4.1% -2.3% -2.1% -2.7% 0.4%
Texas            
+/- m/m N/A N/A N/A N/A N/A N/A
% y/y
Washington 1,607,980 1,603,459 1,601,493 1,588,832 1,588,041 1,545,607
+/- m/m (51) (4,521) (1,966) (12,661) (791) (42,434)
% y/y -2.6% -2.6% -0.4% -3.2% -3.1% -5.4%
West Virginia 410,451 414,581 410,081 410,973 411,070 410,019
+/- m/m (6,170) 4,130 (4,500) 892 97 (1,051)
% y/y 2.7% -3.6% -3.7% -3.8% -3.5% -3.7%
Wisconsin 783,143 802,786 805,477 803,727 812,542 813,681
+/- m/m (3,524) 19,643 2,691 (1,750) 8,815 1,139
% y/y -0.5% 1.2% 0.8% 0.6% 1.9% 2.1%

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 managed Medicaid 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 has declined through June 2018, down over 64,000 since June 2017. At the end of Q2 2018, Arizona’s MCO enrollment stands at 1.5 million, down 4.0 percent from the prior year.

California

Medicaid Expansion Status: Expanded January 1, 2014
Medi-Cal managed care enrollment data through June 2018 shows a decrease of 1.1 percent from the previous year, with managed care enrollment down roughly 119,000 since that time. As of June 2018, enrollment in managed care is approximately 10.7 million.

Florida

Medicaid Expansion Status: Not Expanded
Florida’s statewide Medicaid managed care program has seen a net decline in total covered lives over the last year, and now covers under 3.2 million beneficiaries as of June 2018, down 5.1 percent from the prior year. (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; note also that FL Healthy Kids enrollment was not available for January and April 2018, so the previous month’s enrollment for that program was used).

Georgia

Medicaid Expansion Status: Not Expanded
As of June 2018, Georgia’s Medicaid managed care program covered nearly 1.39 million members, up 7.4 percent from the previous year.

Hawaii

Medicaid Expansion Status: Expanded January 1, 2014
Through September 2017, enrollment in the Hawaii Medicaid managed care program stands at more than 358,000, up 0.6 percent from September 2016. Hawaii has not reported Q2 2018 enrollment figures at the time of publication.

Illinois

Medicaid Expansion Status: Expanded January 1, 2014
Illinois enrollment across the state’s managed care programs sits at nearly 2.3 million as of May 2018, up 17 percent from May 2017.

Indiana

Medicaid Expansion Status: Expanded in 2015 through HIP 2.0
As of May 2018, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—is over 1.1 million. May 2017 enrollment was not available, but compared to year-end 2017, enrollment was down 2 percent.

Iowa

Medicaid Expansion Status: Expanded January 1, 2014
Iowa launched its statewide Medicaid managed care program in April of 2016. Enrollment across all populations sits at over 616,000 as of June 2018. Enrollment is up 0.8 percent from the previous June.

Kansas

Medicaid Expansion Status: Not Expanded
Kansas Medicaid managed care enrollment was over 388,000 as of May 2018. The state has not provided monthly enrollment until this year, so historical comparisons are not available.

Kentucky

Medicaid Expansion Status: Expanded January 1, 2014
As of February 2018, Kentucky covered 1.26 million beneficiaries in risk-based managed care. Total enrollment is down 1.1 percent from the prior year.

Louisiana

Medicaid Expansion Status: Expanded July 1, 2016
Medicaid managed care enrollment in Bayou Health stands at 1.47 million as of May 2018, up 0.4 percent from the previous year. Louisiana’s Medicaid expansion, which began on July 1, 2016, has been a major driver of MCO enrollment growth over the past five quarters.  Enrollment is up 37.7 percent since June 2016.

Maryland

Medicaid Expansion Status: Expanded January 1, 2014
Maryland’s Medicaid managed care program covered nearly 1.19 million as of May 2018, up 1.7 percent from the prior year.

Michigan

Medicaid Expansion Status: Expanded April 1, 2014
As of June 2018, Michigan’s Medicaid managed care sits at 1.82 million, down 1.3 percent from the previous year.

Minnesota

Medicaid Expansion Status: Expanded January 1, 2014
As of June 2018, enrollment across Minnesota’s multiple managed Medicaid programs sits at nearly 982,000, up 6.6 percent from the prior year.

Mississippi

Medicaid Expansion Status: Not Expanded
MississippiCAN, the state’s Medicaid managed care program, grew significantly in 2015. However, net enrollment declines over the past two and a half years have reversed some of this growth. Medicaid managed care membership stands at just over 447,000 as of June 2018, down 8.6 percent from last year.

Missouri

Medicaid Expansion Status: Not Expanded
Missouri managed care enrollment in the Medicaid and CHIP programs sits at more than 712,000 as of June 2018. In May, the first month of the state’s geographic managed care expansion, roughly 240,000 new members were added in the new region.

Nebraska

Medicaid Expansion Status: Not Expanded
As of May 2018, the program enrolled nearly 234,000 members.

New Mexico

Medicaid Expansion Status: Expanded January 1, 2014
As of June 2018, New Mexico’s Centennial Care program covers nearly 661,000 members, a 4.6 percent decline compared to June 2017.

New York

Medicaid Expansion Status: Expanded January 1, 2014
New York’s Medicaid managed care programs collectively covered more than 4.76 million beneficiaries as of June 2018, a 1.4 percent increase from the previous year.

Ohio

Medicaid Expansion Status: Expanded January 1, 2014
As of June 2018, enrollment across all four Ohio Medicaid managed care programs was nearly 2.45 million, down 4.1 percent from the prior year.

Oregon

Medicaid Expansion Status: Expanded January 1, 2014
As of March 2018, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program is nearly 896,000, up 2.8 percent from the prior year.

Pennsylvania

Medicaid Expansion Status: Expanded as of 2015
As of March 2018, Pennsylvania’s Medicaid managed care enrollment sits at more than 2.3 million, up 1.6 percent in the past year.

South Carolina

Medicaid Expansion Status: Not Expanded
South Carolina’s Medicaid managed care programs collectively enroll more than 757,000 members as of June 2018, which represents a decline of 2.3 percent in the past year.

Tennessee

Medicaid Expansion Status: Not Expanded
As of June 2018, TennCare managed care enrollment totaled 1.42 million up 0.4 percent from the prior year.

Texas

Medicaid Expansion Status: Not Expanded
Enrollment reporting out of Texas has been limited in the past year. As of February 2017, Texas managed care enrollment stood at more than 3.94 million across the state’s six managed care programs, having launched STAR KIDS in the second half of 2016. Enrollment was up 2.6 percent from the prior year.

Washington

Medicaid Expansion Status: Expanded January 1, 2014
Washington’s Medicaid managed care enrollment dropped 5.4 percent to 1.55 million as of June 2018, compared to June 2017.

West Virginia

Medicaid Expansion Status: Expanded January 1, 2014
As of June 2018, West Virginia’s managed care program covers 410,000 members, down 3.7 percent year-over-year.

Wisconsin

Medicaid Expansion Status: Not Expanded
Across Wisconsin’s three managed care programs, June 2018 enrollment totals nearly 814,000, up 2.1 percent from the year before.

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.

HMA enhances this publicly available information with an overview of the structure of Medicaid in each state, as well as a proprietary HMA Medicaid Managed Care Opportunity Assessment.

For additional information on how to subscribe to HMA Information Services, contact Carl Mercurio at 212-575-5929 or cmercurio@healthmanagement.com.

[1] Arizona, California, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Mexico, New York, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Washington, West Virginia, Wisconsin.

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