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Medicaid Managed Care Enrollment Update – Q4 2018

This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 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 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) 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 29 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 29 states in this report account for an estimated 49.6 million Medicaid managed care enrollees as of the end of 2018. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that, nationwide, Medicaid MCO enrollment is likely over 54 million in 2018. As such, the enrollment data across these 29 states represents approximately 91 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  • States with managed care that do not publish monthly enrollment reports are Delaware, District of Columbia, Massachusetts, New Hampshire, New Jersey, Nevada, Rhode Island, and Virginia.
  • Across the 29 states tracked in this report, Medicaid managed care enrollment is up 0.6 percent year-over-year as of December 2018.
  • The 18 expansion states listed above have seen net Medicaid managed care enrollment decrease by 273,000 members, or 0.8 percent, in the past year, to 36 million members at the end of Q4 2018.
  • The 11 states that have not yet expanded Medicaid – Florida, Georgia, Kansas, Mississippi, Missouri, Nebraska, South Carolina, Tennessee, Texas, Utah, and Wisconsin – have seen net Medicaid managed care enrollment increase by roughly 587,000 members, or 4.5 percent, to 13.6 million members at the end of Q4 2018.

Table 1 – Monthly MCO Enrollment by State – July 2018 through December 2018

  Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18
Arizona 1,563,150 1,567,540 1,570,108 1,575,945 1,570,969 1,573,735
+/- m/m 7,120 4,390 2,568 5,837 (4,976) 2,766
% y/y -3.5% -3.2% -4.1% -2.6% -2.7% -1.9%
California 10,692,167 10,667,331 10,639,479 10,608,601 10,593,196 10,555,396
+/- m/m (23,217) (24,836) (27,852) (30,878) (15,405) (37,800)
% y/y -1.3% -2.0% -1.9% -2.4% -1.9% -2.4%
Florida 3,266,483 3,271,590 3,268,944 3,266,948 3,239,347  
+/- m/m 67,164 5,107 (2,646) (1,996) (27,601) N/A
% y/y -2.6% -1.5% -1.2% -1.9% -1.5%  
Georgia   1,329,866 1,337,449 1,339,383 1,344,518 1,346,936
+/- m/m N/A 1,329,866 7,583 1,934 5,135 2,418
% y/y   0.0% 0.7% -2.2% -1.7% -1.4%
Hawaii 351,642 346,533 348,607      
+/- m/m (2,301) (5,109) 2,074 N/A N/A N/A
% y/y -2.6% -3.7% -2.9%      
Illinois 2,252,196 2,289,559 2,277,405 2,264,019 2,245,537 2,220,643
+/- m/m (7,946) 37,363 (12,154) (13,386) (18,482) (24,894)
% y/y 14.7% 16.7% 16.5% 16.7% 16.0% N/A
Indiana 1,129,472 1,130,048 1,116,043 1,121,083 1,115,510  
+/- m/m (4,001) 576 (14,005) 5,040 (5,573) N/A
% y/y -0.1% -0.6% -2.5% -2.3% -4.4%  
Iowa 618,738 611,720 612,250 612,614 613,072 612,950
+/- m/m 2,498 (7,018) 530 364 458 (122)
% y/y 2.7% 1.6% 2.0% 1.9% 2.2% 4.9%
Kansas 383,815 383,245 382,841 387,442 388,269  
+/- m/m (4,235) (570) (404) 4,601 827 N/A
% y/y -9.6% -9.2% -8.8% -7.3% -6.9%  
Kentucky 1,258,384 1,259,190 1,242,693 1,241,443 1,241,969 1,229,023
+/- m/m (7,255) 806 (16,497) (1,250) 526 (12,946)
% y/y 1.0% 0.6% -0.7% -0.8% -1.2% -2.1%
Louisiana 1,471,815 1,475,017 1,483,547 1,484,101 1,490,295  
+/- m/m 2,843 3,202 8,530 554 6,194 N/A
% y/y 0.2% 1.0% 1.5% 1.2% 1.7%  
Maryland 1,179,919 1,185,497 1,187,064 1,178,419    
+/- m/m 995,429 5,578 1,567 (8,645) N/A N/A
% y/y 0.8% 1.5% 2.1% 0.9%    
Michigan 1,821,158 1,811,011 1,825,844 1,813,132 1,790,536 1,785,323
+/- m/m 953 (10,147) 14,833 (12,712) (22,596) (5,213)
% y/y -2.0% -2.2% 0.8% -0.5% -1.3% -1.8%
Minnesota 979,563 972,377 974,207 966,674 961,185 945,070
+/- m/m (2,422) (7,186) 1,830 (7,533) (5,489) (16,115)
% y/y 4.7% 3.7% 3.1% 1.0% -0.1% -1.4%
Mississippi 441,782 433,139 432,195 427,819 434,047 437,875
+/- m/m (5,481) (8,643) (944) (4,376) 6,228 3,828
% y/y -9.3% -10.4% -10.1% -11.2% -9.4% -8.0%
Missouri 702,857 693,642 677,621 663,265    
+/- m/m (9,478) (9,215) (16,021) (14,356) N/A N/A
% y/y -3.7% -4.2% -5.9% -7.3%    
Nebraska 231,685 231,185 232,621 231,587 231,503 231,201
+/- m/m (2,135) (500) 1,436 (1,034) (84) (302)
% y/y 1.3% 1.9% 2.2% 1.5% 1.1% 1.2%
New Mexico 656,708 655,994 654,670 658,408 659,197 659,943
+/- m/m (4,210) (714) (1,324) 3,738 789 746
% y/y -4.4% -3.3% -1.2% -0.8% -0.6% -0.7%
New York 4,763,799 4,739,406 4,731,360 4,717,445 4,728,994 4,732,081
+/- m/m 404 (24,393) (8,046) (13,915) 11,549 3,087
% y/y 1.1% 1.1% 1.1% 0.5% 0.6% 0.3%
Ohio 2,441,134 2,427,042 2,417,360 2,407,082 2,392,133 2,362,006
+/- m/m (8,837) (14,092) (9,682) (10,278) (14,949) (30,127)
% y/y -3.9% -4.1% -3.8% -3.9% -4.1% -4.9%
Oregon 890,235 893,608 890,633 898,048 895,080 890,478
+/- m/m (6,152) 3,373 (2,975) 7,415 (2,968) (4,602)
% y/y 2.2% 2.7% 3.4% 3.7% 2.2% N/A
Pennsylvania 2,317,997 2,309,442 2,298,494 2,292,042 2,284,179  
+/- m/m (10,373) (8,555) (10,948) (6,452) (7,863) N/A
% y/y 0.8% 0.3% -0.2% -0.5% -0.9%  
South Carolina 767,421 762,297 774,172 776,032 776,878 788,555
+/- m/m 23,553 (5,124) 11,875 1,860 846 11,677
% y/y -1.6% -2.0% 0.8% 0.6% 0.3% 1.4%
Tennessee 1,387,156 1,326,600 1,334,227 1,345,085 1,337,201 1,346,785
+/- m/m (31,251) (60,556) 7,627 10,858 (7,884) 9,584
% y/y -1.0% -6.8% -6.9% -7.0% -8.5% -7.9%
Texas   4,157,900        
+/- m/m N/A N/A N/A N/A N/A N/A
% y/y   N/A        
Utah 242,320 241,384 239,254 237,882 237,326 234,418
+/- m/m 242,320 (936) (2,130) (1,372) (556) (2,908)
% y/y N/A N/A N/A N/A N/A N/A
Washington 1,580,002          
+/- m/m 34,395 N/A N/A N/A N/A N/A
% y/y -2.4%          
West Virginia 407,223 405,368 403,341 399,696 398,689 395,819
+/- m/m (2,796) (1,855) (2,027) (3,645) (1,007) (2,870)
% y/y -4.1% -3.9% -4.0% -4.4% -4.4% -5.0%
Wisconsin 806,155 804,474 804,979 797,563 798,775 796,611
+/- m/m (7,526) (1,681) 505 (7,416) 1,212 (2,164)
% y/y 1.1% 1.4% 1.5% 0.9% 1.3% 1.3%

 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 has declined through December 2018, down over 30,000 since December 2017. At the end of 2018, Arizona’s MCO enrollment stands at 1.6 million, down 1.9 percent from the prior year.

California

Medicaid Expansion Status: Expanded January 1, 2014
Medi-Cal managed care enrollment data shows a decrease of 2.4 percent in 2018, with managed care enrollment down roughly 264,000 since 2017. As of December 2018, enrollment in managed care is approximately 10.6 million.

Florida

Medicaid Expansion Status: Not Expanded
Florida’s statewide Medicaid managed care program has seen a 1.5 percent net decline in total covered lives over the last year to 3.2 million beneficiaries as of November 2018. (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 December 2018, Georgia’s Medicaid managed care program covered over 1.3 million members, down 1.4 percent from the previous year.

Hawaii

Medicaid Expansion Status: Expanded January 1, 2014
Through September 2018, enrollment in the Hawaii Medicaid managed care program stands at nearly 349,000, down 2.9 percent from September 2017.

Illinois

Medicaid Expansion Status: Expanded January 1, 2014
Illinois enrollment across the state’s managed care programs sits at 2.2 million as of December 2018, up 14.7 percent from November 2017 (December 2017 data was unavailable).

Indiana

Medicaid Expansion Status: Expanded in 2015 through HIP 2.0
As of November 2018, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—is over 1.1 million, up 4.4 percent from the same period the previous 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 613,000 as of December 2018. Enrollment is up 4.9 percent from the previous year.

Kansas

Medicaid Expansion Status: Not Expanded
Kansas Medicaid managed care enrollment was over 388,000 as of November 2018, down 6.9 percent from November 2017.

Kentucky

Medicaid Expansion Status: Expanded January 1, 2014
As of December 2018, Kentucky covered 1.2 million beneficiaries in risk-based managed care. Total enrollment is down 2.1 percent from the prior year.

Louisiana

Medicaid Expansion Status: Expanded July 1, 2016
Medicaid managed care enrollment stands at 1.5 million as of November 2018, up 1.7 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 39.2 percent since June 2016.

Maryland

Medicaid Expansion Status: Expanded January 1, 2014
Maryland’s Medicaid managed care program covered nearly 1.2 million lives as of October 2018, up 0.9 percent from the prior year.

Michigan

Medicaid Expansion Status: Expanded April 1, 2014
As of December 2018, Michigan’s Medicaid managed care sits at 1.8 million, down 1.8 percent from the previous year.

Minnesota

Medicaid Expansion Status: Expanded January 1, 2014
As of December 2018, enrollment across Minnesota’s multiple managed Medicaid programs sits at 945,000, down 1.4 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 three years have reversed some of this growth. Medicaid managed care membership stands at 438,000 as of December 2018, down 8 percent from last year.

Missouri

Medicaid Expansion Status: Not Expanded
Missouri managed care enrollment in the Medicaid and CHIP programs sits at more than 663,000 as of October 2018. In May 2017, the first month of the state’s geographic managed care expansion, roughly 240,000 new members were added in the new region. However, enrollment is now down 7.3 percent in October, compared to the prior year.

Nebraska

Medicaid Expansion Status: Not Expanded
As of December 2018, the program enrolled 231,000 members, up 1.2 percent from the previous year.

New Mexico

Medicaid Expansion Status: Expanded January 1, 2014
As of December 2018, New Mexico’s Centennial Care program covers nearly 660,000 members, down 0.7 percent compared to December 2017.

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 2018, a 0.3 percent increase from the previous year.

Ohio

Medicaid Expansion Status: Expanded January 1, 2014
As of December 2018, enrollment across all four Ohio Medicaid managed care programs was nearly 2.4 million, down 4.9 percent from the prior year.

Oregon

Medicaid Expansion Status: Expanded January 1, 2014
As of December 2018, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program is 890,000. (This figure includes roughly 51,000 enrolled in managed care other than CCO).

Pennsylvania

Medicaid Expansion Status: Expanded as of 2015
As of November 2018, Pennsylvania’s Medicaid managed care enrollment sits at nearly 2.3 million, down 0.9 percent in the past year.

South Carolina

Medicaid Expansion Status: Not Expanded
South Carolina’s Medicaid managed care programs collectively enroll nearly 789,000 members as of December 2018, which represents an increase of 1.4 percent in the past year.

Tennessee

Medicaid Expansion Status: Not Expanded
As of December 2018, TennCare managed care enrollment totaled 1.3 million, down 7.9 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 August 2018, Texas managed care enrollment stood at nearly 4.2 million across the state’s six managed care programs, having launched STAR KIDS in the second half of 2016.

Utah

Medicaid Expansion Status: Not Expanded
As of December 2018, Utah’s Medicaid managed care enrollment was over 234,000. Previous years’ enrollment was unavailable.

Washington

Medicaid Expansion Status: Expanded January 1, 2014
Washington’s Medicaid managed care enrollment dropped 2.4 percent to 1.58 million as of July 2018, compared to July 2017.

West Virginia

Medicaid Expansion Status: Expanded January 1, 2014

As of December 2018, West Virginia’s managed care program covers 396,000 members, down 5 percent year-over-year.

Wisconsin

Medicaid Expansion Status: Not Expanded

Across Wisconsin’s three managed care programs, December 2018 enrollment totals nearly 797,000, up 1.3 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@healthmanagaement.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, Utah, Washington, West Virginia, Wisconsin.

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