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 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 highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2017. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
- Seventeen of the 27 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 27 states in this report account for an estimated 49.3 million Medicaid managed care enrollees as of the end of Q4 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 nearly 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- States with managed care that do not publish monthly enrollment reports are Delaware, District of Columbia, Kansas, Massachusetts, New Hampshire, New Jersey, Nevada, Rhode Island, Utah, and Virginia.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 1.4 percent year-over-year as of December 2017, adding more than 660,000 net new enrollees since December 2016.
- The 18 expansion states listed above have seen net Medicaid managed care enrollment increase by more than 580,000 members, or 1.6 percent, in the past year, to 36.2 million members at the end of Q4 2017.
- The nine states that have not yet expanded Medicaid have seen net Medicaid managed care enrollment increase by roughly 80,000 members, or 0.6% percent, to just over 13 million members at the end of Q4 2017.
Table 1 – Monthly MCO Enrollment by State – July 2017 through December 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 declined slightly through 2017, down nearly 11,000 since year-end 2016. At the end of Q4 2017, Arizona’s MCO enrollment stands at more than 1.6 million, down 0.7 percent from the prior year.
California
Medicaid Expansion Status: Expanded January 1, 2014
Medi-Cal managed care enrollment data through November 2017 shows an increase of 0.8 percent from the previous year, with managed care enrollment up roughly 90,000 since that time. As of November 2017, enrollment in managed care is approximately 10.8 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 3.3 million beneficiaries as of December 2017, down 3 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 November 2017, so the previous month’s enrollment for that program was used).
Georgia
Medicaid Expansion Status: Not Expanded
As of November 2017, Georgia’s Medicaid managed care program covered nearly 1.37 million members, up 4.8 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 Q4 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 November 2017, down 5.3 percent from November 2016.
Indiana
Medicaid Expansion Status: Expanded in 2015 through HIP 2.0
As of November 2017, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—is nearing 1.2 million, up 4 percent from the prior year.
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 nearly 600,000 as of November 2017. Enrollment is down 1.3 percent from the previous November.
Kentucky
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2017, Kentucky covered more than 1.25 million beneficiaries in risk-based managed care. Total enrollment is up more than 2 percent from the prior year.
Louisiana
Medicaid Expansion Status: Expanded July 1, 2016
Medicaid managed care enrollment in Bayou Health stands at more than 1.5 million as of November 2017, up 4.6 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 percent since June of 2016.
Maryland
Medicaid Expansion Status: Expanded January 1, 2014
Maryland’s Medicaid managed care program covered nearly 1.18 million as of November 2017, up 4.1 percent from the prior year.
Michigan
Medicaid Expansion Status: Expanded April 1, 2014
Michigan’s Medicaid managed care growth trend over the past year generally continued through the end of the year. As of December 2017, managed care enrollment sits at more than 1.8 million, up 2.2 percent from the previous year.
Minnesota
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2017, enrollment across Minnesota’s multiple managed Medicaid programs sits at more than 958,000, up nearly 6.2 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 476,000 as of December 2017, down 2.5 percent from last year.
Missouri
Medicaid Expansion Status: Not Expanded
Missouri managed care enrollment in the Medicaid and CHIP programs sits at more than 717,000 as of November 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, November enrollment is up more than 41 percent from the prior year.
Nebraska
Medicaid Expansion Status: Not Expanded
This is now our third quarterly report to include Nebraska, which began reporting monthly enrollment data with the launch of the Heritage Health Medicaid managed care program. As of December 2017, the program enrolled nearly 229,000 members.
New Mexico
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2017, New Mexico’s Centennial Care program covers more than 664,000 members, a 3.7 percent decline compared to year-end 2016.
New York
Medicaid Expansion Status: Expanded January 1, 2014
New York’s Medicaid managed care programs collectively covered more than 4.7 million beneficiaries as of December 2017, a 1.7 percent increase from the previous year.
Ohio
Medicaid Expansion Status: Expanded January 1, 2014
As of November 2017, enrollment across all four Ohio Medicaid managed care programs was nearly 2.5 million, up 1.5 percent from the prior year.
Oregon
Medicaid Expansion Status: Expanded January 1, 2014
As of November 2017, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program is more than 876,000, up 1.2 percent from the prior year.
Pennsylvania
Medicaid Expansion Status: Expanded as of 2015
As of November 2017, Pennsylvania’s Medicaid managed care enrollment sits at more than 2.3 million, up 2.1 percent in the past year.
South Carolina
Medicaid Expansion Status: Not Expanded
South Carolina’s Medicaid managed care programs collectively enroll more than 777,000 members as of December 2017, which represents growth of 1.8 percent in the past year.
Tennessee
Medicaid Expansion Status: Not Expanded
As of November 2017, TennCare managed care enrollment totaled 1.46 million, down 6.7 percent from the prior year. However, enrollment has increased in each of the last four months.
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
Enrollment growth in Washington’s Medicaid managed care is flat as of December 2017, compared to year-end 2016. Total enrollment stands at more than 1.6 million.
West Virginia
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2017, West Virginia’s managed care program covers roughly 416,000 members, up more than 8 percent year-over-year.
Wisconsin
Medicaid Expansion Status: Not Expanded
Across Wisconsin’s three managed care programs, December 2017 enrollment totals nearly 787,000 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. 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 [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.