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Medicaid Managed Care Enrollment Update – Q2 2021

This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 33 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 33 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2020. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):

  • The 33 states in this report account for an estimated 63 million Medicaid managed care enrollees as of June 2021. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that nationwide Medicaid MCO enrollment is likely over 66 million in June 2021. As such, the enrollment data across these 33 states represents approximately 95 percent of all Medicaid MCO enrollment.
  • Oklahoma could add approximately 742,000 Medicaid managed care lives when it transitions from fee-for-service in October 2021. North Carolina has also shifted to managed care in July 2021. Currently there are 2.5 million Medicaid members in the state.
  • States with managed care that do not publish monthly enrollment reports are Colorado, Delaware, Massachusetts, New Hampshire, North Dakota, and Rhode Island.
  • Across the 33 states tracked in this report, Medicaid managed care enrollment is up 13.3 percent year-over-year as of June 2021.
  • All states saw increases in enrollment in June 2021, compared to previous year, due to the high gains from the COVID-19 pandemic.
  • Twenty-three of the 33 states – Arizona, California, District of Columbia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Utah, 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 5.2 million members, or 12.5 percent, in the past year, to 46.8 million members at the end of Q2 2021.
  • The 10 states that have not yet expanded Medicaid as of June 2021 – Florida, Georgia, Kansas, Mississippi, Missouri, Nebraska, South Carolina, Tennessee, Texas, and Wisconsin – have seen Medicaid managed care enrollment increase 15.5 percent to 16.3 million members at the end of Q2 2021. Missouri was originally scheduled to implement its voter-approved Medicaid expansion in July 2021.In August 2021, the state Supreme Court ordered Missouri to immediately implement Medicaid expansion. The state is currently working through administrative hurdles.

Table 1 – Monthly MCO Enrollment by State – January 2021 through June 2021

 Jan-21Feb-21Mar-21Apr-21May-21Jun-21
Arizona1,831,2721,849,6501,865,4051,877,6681,892,669 
+/- m/m19,49418,37815,75512,26315,001N/A
% y/yN/A17.0%17.8%15.7%14.2% 
California11,329,11611,403,84411,476,63411,566,33811,656,62811,712,247
+/- m/m82,37274,72872,79089,70490,29055,619
% y/y11.4%12.0%12.7%12.7%11.8%10.8%
D.C.224,655225,960227,092228,559229,681230,370
+/- m/m2,7761,3051,1321,4671,122689
% y/y16.7%24.9%24.4%23.8%22.4%20.8%
Florida3,740,6583,784,8453,847,1763,855,1803,898,4983,940,026
+/- m/m30,34344,18762,3318,00443,31841,528
% y/y19.5%20.9%23.2%18.0%16.1%15.1%
Georgia1,696,6781,718,4771,735,7311,752,7741,768,1021,783,770
+/- m/m22,20421,79917,25417,04315,32815,668
% y/y23.4%24.8%26.8%26.3%20.0%19.0%
Hawaii403,228406,847412,582416,257418,974421,493
+/- m/m4,7783,6195,7353,6752,7172,519
% y/y18.8%20.3%20.9%18.6%17.6%16.5%
Illinois2,649,2932,663,4492,691,1622,707,7012,708,8442,727,103
+/- m/m19,90214,15627,71316,5391,14318,259
% y/y22.1%21.5%22.5%22.0%20.8%18.1%
Indiana1,453,7191,474,5891,497,9071,514,5831,533,1501,547,379
+/- m/m23,43820,87023,31816,67618,56714,229
% y/y30.2%30.9%30.1%26.3%23.8%21.6%
Iowa721,717729,124734,313740,240745,000747,127
+/- m/m7,2187,4075,1895,9274,7602,127
% y/y13.6%15.0%15.6%13.8%12.2%11.1%
Kansas 434,773  443,136 
+/- m/mN/AN/AN/AN/AN/AN/A
% y/y   12.3% 
Kentucky01,489,9511,500,9391,509,3201,516,3281,527,838
+/- m/m0010,9888,3817,00811,510
% y/y0.0%25.0%25.5%21.7%20.4%20.6%
Louisiana1,695,1871,706,7811,708,6841,717,0821,723,5761,733,148
+/- m/m43,86611,5941,9038,3986,4949,572
% y/yN/A15.6%14.6%12.1%11.1%N/A
Maryland1,349,1581,358,7311,367,9901,378,8031,388,4191,395,950
+/- m/m20,8909,5739,25910,8139,6167,531
% y/y12.7%13.3%12.8%12.6%11.8%10.9%
Michigan2,105,6082,123,9992,144,2282,158,8992,174,7022,186,010
+/- m/m23,09718,39120,22914,67115,80311,308
% y/y17.6%18.1%18.5%18.2%16.6%13.8%
Minnesota1,105,9401,119,5311,131,0431,144,7161,155,3081,162,923
+/- m/m14,98613,59111,51213,67310,5927,615
% y/y24.3%23.6%23.7%20.3%16.8%15.0%
Mississippi480,405484,232485,435485,995488,759490,408
+/- m/m4,7693,8271,2035602,7641,649
% y/y10.3%11.4%12.5%12.6%12.1%10.2%
Missouri768,817775,571783,448793,871801,679808,780
+/- m/m12,3566,7547,87710,4237,8087,101
% y/y33.6%34.3%35.0%31.0%25.0%23.0%
Nebraska295,175301,079305,315310,836315,846319,663
+/- m/m9,8215,9044,2365,5215,0103,817
% y/y28.3%29.0%31.0%34.5%31.1%30.2%
Nevada595,680599,348607,344617,590619,721623,495
+/- m/m13,7353,6687,99610,2462,1313,774
% y/y0.0%0.0%0.0%34.6%22.2%20.0%
New Jersey1,854,5721,875,2221,892,6651,913,2711,929,6611,939,342
+/- m/m16,73920,65017,44320,60616,3909,681
% y/y17.1%18.1%18.9%17.6%16.0%14.2%
New Mexico754,070758,197762,714766,786769,774773,465
+/- m/m5,6874,1274,5174,0722,9883,691
% y/y12.1%12.6%13.1%11.6%0.0%9.7%
New York5,494,3135,496,1835,459,4965,502,6745,538,7065,570,256
+/- m/m116,0951,870(36,687)43,17836,03231,550
% y/y19.3%19.2%18.7%17.7%15.6%13.0%
Ohio2,760,8812,780,1332,801,0032,815,7572,832,2542,849,230
+/- m/m19,88719,25220,87014,75416,49716,976
% y/y15.0%N/A16.2%12.2%N/A9.5%
Oregon1,045,8561,061,7121,070,1111,078,5311,086,3271,097,817
+/- m/m13,02615,8568,3998,4207,79611,490
% y/y16.8%18.3%18.7%17.6%14.9%13.9%
Pennsylvania2,577,6182,603,0732,626,3832,645,9092,666,0882,679,585
+/- m/m36,11425,45523,31019,52620,17913,497
% y/y15.4%16.3%17.5%17.1%14.7%12.9%
South Carolina931,108942,592950,466959,363968,794975,482
+/- m/m8,21711,4847,8748,8979,4316,688
% y/y15.0%16.3%18.1%0.0%15.2%14.0%
Tennessee1,538,5581,546,5321,558,4461,567,6761,580,5311,589,256
+/- m/m12,5277,97411,9149,23012,8558,725
% y/y8.2%8.8%9.7%10.8%10.4%9.7%
Texas 4,766,449  4,902,864 
+/- m/mN/AN/AN/AN/AN/AN/A
% y/y   16.0% 
Utah333,673340,958345,762351,597357,233356,529
+/- m/m5,9297,2854,8045,8355,636(704)
% y/y36.1%37.2%39.2%35.4%32.3%28.0%
Virginia1,335,1671,348,1191,363,3041,376,0441,387,7631,401,512
+/- m/m26,39012,95215,18512,74011,71913,749
% y/y21.3%21.7%22.0%21.9%17.9%16.8%
Washington1,730,1191,721,7681,734,8841,745,0521,754,7091,761,349
+/- m/m28,176(8,351)13,11610,1689,6576,640
% y/y13.5%13.3%13.3%12.8%12.0%10.9%
West Virginia463,057465,300457,534476,398481,337484,591
+/- m/m6,7952,243(7,766)18,8644,9393,254
% y/y20.8%20.2%19.7%15.8%14.7%13.7%
Wisconsin1,022,4771,035,6671,047,0131,056,8481,064,900 
+/- m/m15,81513,19011,3469,8358,052N/A
% y/y26.7%27.0%28.0%23.7%20.3% 

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 had grown to 1.9 million in May 2021, up 14.2 percent from May 2020.

California

Medicaid Expansion Status: Expanded January 1, 2014

Medi-Cal managed care enrollment was up 10.8 percent year-over-year to 11.7 million, as of June 2021.

District of Columbia

Medicaid Expansion Status: Expanded January 1, 2014

Medicaid managed care enrollment in the District of Columbia was up 20.8 percent to approximately 230,000 in June 2021.

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Florida

Medicaid Expansion Status: Not Expanded

Florida’s statewide Medicaid managed care program had seen a 15.1 percent rise in total covered lives over the last year to 3.9 million beneficiaries as of June 2021. (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).

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Georgia

Medicaid Expansion Status: Not Expanded

As of June 2021, Georgia’s Medicaid managed care program covered nearly 1.8 million members, up 19 percent from the previous year.

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Hawaii

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, enrollment in the Hawaii Medicaid managed care program stood at 421,500, up 16.5 percent from the previous year.

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Illinois

Medicaid Expansion Status: Expanded January 1, 2014

Illinois enrollment across the state’s managed care programs was up 18.1 percent to 2.7 million as of June 2021.

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Indiana

Medicaid Expansion Status: Expanded in 2015 through HIP 2.0

As of June 2021, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—was more than 1.5 million, up 21.6 percent from June 2020.

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Iowa

Medicaid Expansion Status: Expanded January 1, 2014

Iowa launched its statewide Medicaid managed care program in April of 2016. Enrollment across all populations sat at 747,000 as of June 2021. Enrollment was up 11.1 percent from the previous year.

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Kansas

Medicaid Expansion Status: Not Expanded

Kansas Medicaid managed care enrollment was more than 443,000 as of May 2021, up 12.3 percent from the previous year.

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Kentucky

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, Kentucky covered more than 1.5 million beneficiaries in risk-based managed care. Total enrollment was up 20.6 percent from the prior year.

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Louisiana

Medicaid Expansion Status: Expanded July 1, 2016

Medicaid managed care enrollment in Louisiana was more than 1.7 million as of June 2021.

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Maryland

Medicaid Expansion Status: Expanded January 1, 2014

Maryland’s Medicaid managed care program covered nearly 1.4 million lives as of June 2021.

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Michigan

Medicaid Expansion Status: Expanded April 1, 2014

As of June 2021, Michigan’s Medicaid managed care was up 13.8 percent to 2.2 million.

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Minnesota

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, enrollment across Minnesota’s multiple managed Medicaid programs was  nearly 1.2 million, up 15 percent from the prior year.

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Mississippi

Medicaid Expansion Status: Not Expanded

MississippiCAN, the state’s Medicaid managed care program, had membership up 10.2 percent to 490,000 as of June 2021.

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Missouri

Medicaid Expansion Status: Delayed from July 2021

Missouri managed care enrollment in the Medicaid and CHIP programs sat at nearly 809,000 in June 2021. Missouri was scheduled to implement its voter-approved Medicaid expansion in July 2021. However, this has been delayed following a budgeting dispute.

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Nebraska

Medicaid Expansion Status: Expanded October 1, 2020

As of June 2021, Nebraska’s Medicaid managed care program enrolled 319,700 members, up 30.2 percent from the previous year.

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Nevada

Medicaid Expansion Status: Expanded January 1, 2014

Nevada’s Medicaid managed care enrollment was up 20 percent to nearly 623,500 as of June 2021.

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New Jersey

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, New Jersey Medicaid managed care enrollment was up 14.2 percent to more than 1.9 million.

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New Mexico

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, New Mexico’s Centennial Care program covered more than 773,000 members, up 9.7 percent from the previous year.

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New York

Medicaid Expansion Status: Expanded January 1, 2014

New York’s Medicaid managed care programs collectively covered 5.6 million beneficiaries as of June 2021, a 13 percent increase from the previous year. New York phased out its Fully Integrated Duals Advantage (FIDA) Demonstration in December 2019 and moved all FIDA enrollees into that plan’s Medicaid Advantage Plus (MAP) plan. The FIDA-IDD program serves about 1,700 members.

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Ohio

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, enrollment across all four Ohio Medicaid managed care programs was more than 2.8 million, up 9.5 percent from the prior year.

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Oregon

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program was nearly 1.1 million. (This figure includes roughly 1,500 enrolled in managed care other than CCO).

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Pennsylvania

Medicaid Expansion Status: Expanded January 1, 2015

As of June 2021, Pennsylvania’s Medicaid managed care enrollment was nearly 2.7 million, up 12.9 percent in the past year.

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South Carolina

Medicaid Expansion Status: Not Expanded

South Carolina’s Medicaid managed care programs collectively enrolled nearly 975,500 members as of June 2021, which represents an increase of 14 percent in the past year.

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Tennessee

Medicaid Expansion Status: Not Expanded

As of June 2021, TennCare managed care enrollment totaled 1.6 million, up 9.7 percent from the prior year.

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Texas

Medicaid Expansion Status: Not Expanded

Enrollment reporting out of Texas has been limited in the past couple of years. As of May 2021, Texas Medicaid managed care enrollment was more than 4.9 million across the state’s six managed care programs, up 16 percent from May 2020.

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Utah

Medicaid Expansion Status: Expanded January 1, 2020

As of June 2021, Utah’s Medicaid managed care enrollment was nearly 357,000, up 28 percent from the previous year. The state implemented the Utah Medicaid Integrated Care (UMIC) program effective January 1, 2020. The program manages physical and behavioral benefits through integrated managed care plans in five counties. Adult expansion Medicaid members in Davis, Salt Lake, Utah, Washington, and Weber counties are required to enroll in a UMIC plan.

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Virginia

Medicaid Expansion Status: January 1, 2019

Virginia Medicaid managed care enrollment was up 16.8 percent in June 2021 to 1.4 million members.

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Washington

Medicaid Expansion Status: Expanded January 1, 2014

Washington’s Medicaid managed care enrollment increased 10.9 percent to 1.8 million as of June 2021, compared to June 2020. 

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West Virginia

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2021, West Virginia’s Medicaid managed care program covered 485,000 members, up 13.7 percent year-over-year.

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Wisconsin

Medicaid Expansion Status: Not Expanded

Across Wisconsin’s three Medicaid managed care programs, May 2021 enrollment totaled 1 million, up 20.3 percent from the year before.

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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@healthmanagaement.com.


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

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