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Quarterly Medicaid Managed Care Enrollment Update – Q2 2017

This In Focus article was originally published in the July 12, 2017 HMA Weekly Roundup.

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 second quarter (Q2) 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 49.4 million Medicaid managed care enrollees as of the end of Q2 2017. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that, nationwide, Medicaid MCO enrollment is nearing 55 million midway through 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  • States with managed care that do not publish monthly enrollment reports are Delaware, District of Columbia, Kansas, Massachusetts, New Hampshire, New Jersey, Nevada, Rhode Island, Utah and Virginia.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 3.3 percent year-over-year as of June 2017, adding nearly 1.6 million net new enrollees since June 2016.
  • The 18 expansion states listed above have seen net Medicaid managed care enrollment increase by 1.2 million members, or 3.4 percent, in the past year, to 36.3 million members at the end of Q2 2017.
  • The nine states that have not yet expanded Medicaid have seen net Medicaid managed care enrollment increase by roughly 380,000 members, or 3 percent, to just over 13 million members at the end of Q2 2017.

Table 1 – Monthly MCO Enrollment by State – January 2017 through June 2017

  Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17
Arizona 1,615,089 1,617,588 1,617,167 1,616,920 1,622,091 1,620,491
+/- m/m 98 2,499 (421) (247) 5,171 (1,600)
% y/y 3.5% 4.4% 3.6% 4.0% 4.4% 3.8%
California 10,746,701 10,804,390 10,841,508 10,844,812 10,854,028 10,833,973
+/- m/m 20,234 57,689 37,118 3,304 9,216 (20,055)
% y/y 4.0% 3.6% 4.1% 3.7% 3.6% 2.5%
Florida 3,409,312 3,403,637 3,400,808 3,380,733 3,388,679 3,370,302
+/- m/m 16,653 (5,675) (2,829) (20,075) 7,946 (18,377)
% y/y 5.1% 2.8% 2.3% 1.9% 1.5% 0.5%
Georgia 1,296,381         1,292,403
+/- m/m 679 N/A N/A N/A N/A (3,978)
% y/y -1.0% -2.4%
Hawaii 361,044 359,778 356,448      
+/- m/m 4,599 358,674 (3,330) N/A N/A N/A
% y/y 3.7% 3.2% 2.0%
Illinois   1,966,377 1,983,627 1,969,457 1,949,742  
+/- m/m N/A (86,588) 17,250 (14,170) (19,715) N/A
% y/y -4.8% -3.5% -4.0% -5.8%
Indiana 1,124,963   1,145,173 1,138,131    
+/- m/m 4,768 N/A 20,210 (7,042) N/A N/A
% y/y 5.8% 5.5% 4.6%
Iowa 618,392 617,745 617,103 614,927 613,525 611,588
+/- m/m 12,684 (647) (642) (2,176) (1,402) (1,937)
% y/y N/A N/A N/A 2.5% 1.5% 0.6%
Kentucky 1,275,445 1,274,155 1,271,545 1,238,153 1,238,323 1,251,273
+/- m/m 44,781 (1,290) (2,610) (33,392) 170 12,950
% y/y 5.4% 7.0% 6.1% 1.7% 2.6% 1.7%
Louisiana 1,430,252 1,451,754 1,466,469 1,461,812    
+/- m/m 17,068 21,502 14,715 (4,657) N/A N/A
% y/y 31.5% 33.3% 35.0% 35.3%
Maryland 1,140,931 1,149,980 1,165,175 1,170,055 1,165,439  
+/- m/m 7,062 9,049 15,195 4,880 (4,616) N/A
% y/y 12.5% 13.1% 11.8% 10.2% 8.1%
Michigan 1,794,404 1,799,306 1,814,658 1,845,179 1,846,561 1,843,559
+/- m/m 16,690 4,902 15,352 30,521 1,382 (3,002)
% y/y 6.5% 6.6% 5.8% 7.3% 6.5% 5.7%
Minnesota 878,263 895,355 906,540 923,468 910,690 921,373
+/- m/m (24,080) 17,092 11,185 16,928 (12,778) 10,683
% y/y 10.5% 12.6% 14.0% 16.2% 14.6% 15.9%
Mississippi 491,073 489,593 488,853 489,302    
+/- m/m 2,674 (1,480) (740) 449 N/A N/A
% y/y -2.4% -3.4% -3.7% -2.8%
Missouri 506,238 502,106 502,049 500,609 742,424  
+/- m/m (1,380) (4,132) (57) (1,440) 241,815 N/A
% y/y 5.0% 3.3% 2.7% 1.8% 50.4%
Nebraska 225,746 226,286 226,314 226,835 226,690 227,847
+/- m/m N/A 540 28 521 (145) 1,157
% y/y N/A N/A N/A N/A N/A N/A
New Mexico 694,013 697,689 700,810 698,723 695,889 692,787
+/- m/m 3,968 3,676 3,121 (2,087) (2,834) (3,102)
% y/y 5.9% 5.4% 5.2% 4.9% 3.9% 3.0%
New York 4,632,203 4,635,859 4,658,721 4,665,355 4,679,089 4,699,230
+/- m/m (4,481) 3,656 22,862 6,634 13,734 20,141
% y/y -1.3% -0.7% 0.2% 0.3% 0.0% 0.8%
Ohio 2,498,780 2,518,144 2,526,742 2,541,714 2,353,267 2,554,558
+/- m/m 20,082 19,364 8,598 14,972 (188,447) 201,291
% y/y 4.3% 3.6% 3.3% 3.9% -4.8% 3.4%
Oregon 846,720 846,758 865,701 881,286 895,687  
+/- m/m (15,320) 38 18,943 15,585 14,401 N/A
% y/y -10.8% -12.3% -11.7% -6.8% -4.5%
Pennsylvania 2,273,484 2,287,369 2,297,906   2,296,670  
+/- m/m 6,870 13,885 10,537 N/A (1,236) N/A
% y/y 5.7% 5.4% 4.8% 3.9%
South Carolina 762,418 767,421 770,035 777,374 774,266 775,542
+/- m/m (1,259) 5,003 2,614 7,339 (3,108) 1,276
% y/y 8.1% 7.3% 7.1% 6.3% 5.1% 3.8%
Tennessee 1,542,563 1,514,370 1,480,077 1,461,966 1,454,231 1,412,063
+/- m/m (16,646) (28,193) (34,293) (18,111) (7,735) (42,168)
% y/y 2.9% 0.0% -3.0% -4.7% -5.8% -8.9%
Texas   3,940,351        
+/- m/m N/A 5,764 N/A N/A N/A N/A
% y/y 2.6%
Washington 1,650,621 1,645,698 1,607,436 1,641,363 1,639,214 1,633,172
+/- m/m 43,126 (4,923) (38,262) 33,927 (2,149) (6,042)
% y/y 12.8% 11.3% 6.5% 8.2% 4.8% 4.2%
West Virginia 399,630 429,907 426,030 426,994 425,889 425,666
+/- m/m 14,598 30,277 (3,877) 964 (1,105) (223)
% y/y 7.6% 15.4% 13.6% 11.1% 10.4% 10.0%
Wisconsin 787,096 793,055 798,959 799,068 797,109 796,716
+/- m/m (6,198) 5,959 5,904 109 (1,959) (393)
% y/y -0.3% -0.3% -1.0% -0.3% -0.8% -0.7%

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 in the first half of 2017, adding a net 5,500 members. At the end of Q2 2017, Arizona’s MCO enrollment stands at more than 1.62 million, up 3.8 percent year-over-year.

California

Medicaid Expansion Status: Expanded January 1, 2014

Medi-Cal managed care enrollment data through June 2017 shows minimal growth, with membership up less than 110,000 over the last six months. As of June 2017, enrollment in managed care is approximately 10.83 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 slight declines in total covered lives in the first half of the year, and now covers just 3.37 million beneficiaries as of June 2017, up just 0.5 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 June 2017, Georgia’s Medicaid managed care program enrolled just under 1.3 million members, down slightly from the previous reporting period and down 2.4 percent from the prior year.

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 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 May 2017, down 5.8 percent from the previous May. 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 April 2017, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—is nearing 1.2 million, up 4.6 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 more than 611,000 as of June 2017. Despite some slight enrollment declines month-to-month in 2017, June 2017 enrollment is still up more than half a percent from June 2016..

Kentucky

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2017, Kentucky enrolled more than 1.25 million beneficiaries in risk-based managed care. Total enrollment is up a little under 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 1.46 million as of April 2017, up 35.3 percent from the previous year. Louisiana’s Medicaid expansion began on July 1, 2016, and is the major driver of MCO enrollment growth since Q3 2016.

Maryland

Medicaid Expansion Status: Expanded January 1, 2014

Maryland’s Medicaid managed care enrollment has shown relatively steady growth over the past year, with May 2017 enrollment coming in at more than 1.16 million, up 8.1 percent from the prior year.

Michigan

Medicaid Expansion Status: Expanded April 1, 2014

Michigan’s Medicaid managed care growth trend over the past year has generally continued into 2017. As of June 2017, managed care enrollment has surpassed 1.8 million, up 5.7 percent from the previous year.

Minnesota

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2017, enrollment across Minnesota’s multiple managed Medicaid programs sits at more than 921,000, up 15.9 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 18 months have reversed some of this growth. Medicaid managed care membership stands at just over 489,000 as of April 2017, down 2.8 percent from last year.

Missouri

Medicaid Expansion Status: Not Expanded

Missouri managed care enrollment in the Medicaid and CHIP programs sits at more than 742,000 as of May 2017. In the first month of the state’s geographic managed care expansion, roughly 240,000 new members were added in the new region, bringing total enrollment up more than 50 percent from May 2016.

Nebraska

Medicaid Expansion Status: Not Expanded

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

New Mexico

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2017, the New Mexico’s Centennial Care program enrolls more than 692,000 members. Enrollment in the first six months of 2017 has been relatively stable, with total enrollment up 3 percent from June 2016.

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 June 2017, roughly flat from the previous year.

Ohio

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2017, enrollment across all four Ohio Medicaid managed care programs has surpassed 2.55 million, up 3.4 percent from the prior year.

Oregon

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2017, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program sits at just under 896,000, down 4.5 percent from the prior year.

Pennsylvania

Medicaid Expansion Status: Expanded as of 2015

As of May 2017, Pennsylvania’s Medicaid managed care enrollment sits at nearly 2.3 million, up 3.9 percent in the past year.

South Carolina

Medicaid Expansion Status: Not Expanded

South Carolina’s Medicaid managed care programs collectively enroll a little under 770,000 members, which represents 3.8 percent growth in the past year.

Tennessee

Medicaid Expansion Status: Not Expanded

As of June 2017, TennCare managed care enrollment totaled 1.4 million, down nearly 9 percent from the prior year. Enrollment has declined in each of the past six months, losing nearly 150,000 net members in the first half of the year.

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 June 2017 stands a little over 1.63 million. This represents a 4.2 percent increase from the prior year.

West Virginia

Medicaid Expansion Status: Expanded January 1, 2014

As of June 2017, West Virginia’s managed care program enrolls roughly 425,000 members, up roughly 10 percent year-over-year.

Wisconsin

Medicaid Expansion Status: Not Expanded

Across the state’s three managed care programs, June 2017 enrollment totals nearly 800,000, 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 cmercurio@healthmanagaement.com.

[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.

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