Medicaid Managed Care Enrollment Update – Q3 2017

This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 27 states.[1] Many state Medicaid agencies elect to 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 27 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2017. This report reflects the most recent data posted.

Seventeen of the 27 states in Table 1 (below) – 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 27 states in this report account for an estimated 49.2 million Medicaid managed care enrollees as of the end of Q3 2017. 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 55 million in the second half of 2017. As such, the enrollment data across these 27 states represents more than 90 percent of all Medicaid MCO enrollment.
• States with managed care that do not publish monthly enrollment reports are Delaware, District of Columbia, Kansas, Massachusetts, New Hampshire, New Jersey, Nevada, Rhode Island, Utah, and Virginia.
• Across the 27 states tracked in this report, Medicaid managed care enrollment is up nearly 2 percent year-over-year as of September 2017, adding roughly 900,000 net new enrollees since September 2016.
• The 18 expansion states listed above have seen net Medicaid managed care enrollment increase by roughly 600,000 members, or 1.7 percent, in the past year, to 36.2 million members at the end of Q3 2017.
• The nine states that have not yet expanded Medicaid have seen net Medicaid managed care enrollment increase by roughly 286,000 members, or 2.2 percent, to just over 13 million members at the end of Q3 2017.

Table 1 – Monthly MCO Enrollment by State – April 2017 through September 2017

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 been stable through of 2017, adding a net 20,000 members in the second and third quarters of the year. At the end of Q3 2017, Arizona’s MCO enrollment stands at more than 1.63 million, up 2.8 percent year-over-year.

California

Medicaid Expansion Status: Expanded January 1, 2014

Medi-Cal managed care enrollment data through September 2017 shows minimal growth, with membership up roughly 3,000 over the last six months. As of September 2017, enrollment in managed care is approximately 10.84 million, a 2.5 percent increase over the previous year.

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 six months, and now covers just over 3.3 million beneficiaries as of September 2017, down 2 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).

Georgia

Medicaid Expansion Status: Not Expanded

As of August 2017, Georgia’s Medicaid managed care program enrolled more than 1.3 million members, up slightly from the previous reporting period.

Hawaii

Medicaid Expansion Status: Expanded January 1, 2014

Through March 2017, enrollment in the Hawaii Medicaid managed care program stands at more than 356,000, up 2.0 percent from Q1 2016. Hawaii has not reported Q2 or Q3 2017 enrollment figures at the time of publication.

Illinois

Medicaid Expansion Status: Expanded January 1, 2014

Illinois enrollment across the state’s four managed care programs sits at just under 2 million as of August 2017, down 5.2 percent from the previous August. The state’s managed care programs lost more than 100,000 net enrollees so far in the first half of 2017.

Indiana

Medicaid Expansion Status: Expanded in 2015 through HIP 2.0

As of August 2017, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—is nearing 1.2 million, up 2.9 percent from the prior year.

Iowa

Medicaid Expansion Status: Expanded January 1, 2014

Iowa launched its new statewide Medicaid managed care program in April of 2016. Enrollment across all populations sits at just over 600,000 as of September 2017. After several consecutive month-to-month enrollment declines in 2017, enrollment is now down just around 1 percent from last year.

Kentucky

Medicaid Expansion Status: Expanded January 1, 2014

As of August 2017, Kentucky enrolled more than 1.25 million beneficiaries in risk-based managed care. Total enrollment is up a more than 5 percent from the prior year.

Louisiana

Medicaid Expansion Status: Expanded July 1, 2016

Medicaid managed care enrollment in Bayou Health stands at more than 1.46 million as of August 2017, up 9.2 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.

Maryland

Medicaid Expansion Status: Expanded January 1, 2014

Maryland’s Medicaid managed care enrollment has shown relatively steady growth over the past year, with September 2017 enrollment coming in at more than 1.16 million, up 4.9 percent from the prior year.

Michigan

Medicaid Expansion Status: Expanded April 1, 2014

Michigan’s Medicaid managed care growth trend over the past year has generally continued throughout 2017, although August and September show two consecutive months of net enrollment decrease. As of September 2017, managed care enrollment sits at more than 1.8 million, up 4.2 percent from the previous year.

Minnesota

Medicaid Expansion Status: Expanded January 1, 2014

As of September 2017, enrollment across Minnesota’s multiple managed Medicaid programs sits at more than 944,000, up nearly 19 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 years have reversed some of this growth. Medicaid managed care membership stands at just over 483,000 as of August 2017, down 2.7 percent from last year.

Missouri

Medicaid Expansion Status: Not Expanded

Missouri managed care enrollment in the Medicaid and CHIP programs sits at more than 724,000 as of August 2017. In May, the first month of the state’s geographic managed care expansion, roughly 240,000 new members were added in the new region. Despite a few months of enrollment decline since, August enrollment is up more than 45 percent from the prior year.

Nebraska

Medicaid Expansion Status: Not Expanded

This is now our second quarterly report to include Nebraska, which began reporting monthly enrollment data with the launch of the Heritage Health Medicaid managed care program. As of August 2017, the program enrolled nearly 228,000 members.

New Mexico

Medicaid Expansion Status: Expanded January 1, 2014

As of September 2017, the New Mexico’s Centennial Care program enrolls more than 662,000 members. Enrollment had decline in each of the last six months, bringing membership down 3 percent in the last year.

New York

Medicaid Expansion Status: Expanded January 1, 2014

New York’s Medicaid managed care programs collectively enrolled just under 4.7 million beneficiaries as of September 2017, roughly flat from the previous year.

Ohio

Medicaid Expansion Status: Expanded January 1, 2014

As of September 2017, enrollment across all four Ohio Medicaid managed care programs has surpassed 2.5 million, up 1.7 percent from the prior year.

Oregon

Medicaid Expansion Status: Expanded January 1, 2014

As of August 2017, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program sits at just under 870,000, up roughly a percent from the prior year.

Pennsylvania

Medicaid Expansion Status: Expanded as of 2015

As of August 2017, Pennsylvania’s Medicaid managed care enrollment sits at more than 2.3 million, up 2.9 percent in the past year.

South Carolina

Medicaid Expansion Status: Not Expanded

South Carolina’s Medicaid managed care programs collectively enroll 777,000 members as of August 2017, which represents growth of more than 2 percent in the past year.

Tennessee

Medicaid Expansion Status: Not Expanded

As of August 2017, TennCare managed care enrollment totaled 1.42 million, down nearly 9 percent from the prior year. Enrollment has declined significantly in the first several months of the year, with August 2017 showing the first reversal in the trend.

Texas

Medicaid Expansion Status: Not Expanded

Enrollment reporting out of Texas has been limited in the past nine months. As of February 2017, Texas managed care enrollment stands 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 is up 2.6 percent from the prior year.

Washington

Medicaid Expansion Status: Expanded January 1, 2014

Washington’s Medicaid managed care enrollment as of September 2017 stands at just under 1.6 million. This represents a 1.6 percent increase from the prior year.

West Virginia

Medicaid Expansion Status: Expanded January 1, 2014

As of September 2017, West Virginia’s managed care program enrolls roughly 420,000 members, up nearly 8 percent year-over-year.

Wisconsin

Medicaid Expansion Status: Not Expanded

Across the state’s three managed care programs, September 2017 enrollment totals nearly 793,000, down less than 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. There is also 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 [email protected].

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