This week, we reviewed recent Medicaid enrollment trends in capitated, risk-based managed care in 24 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 24 states have released monthly Medicaid managed care enrollment data through the third quarter (Q3) of 2016. This report reflects the most recent data posted.
Sixteen of the 24 states in Table 1 (below) – Arizona, California, Hawaii, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Pennsylvania, Washington, and West Virginia – expanded Medicaid under the Affordable Care Act and have seen increased Medicaid managed care enrollment throughout 2014, 2015, and the first three quarters of 2016.
- The 24 states in this report account for an estimated 46.9 million Medicaid managed care enrollees as of the end of Q3 2016. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that, nationwide, Medicaid MCO enrollment has surpassed 52 million in the first three quarters of 2016. As such, the enrollment data across these 24 states represents between 85 percent and 90 percent of all Medicaid MCO enrollment.
- Across the 24 states tracked in this report, Medicaid managed care enrollment is up 4.5 percent year-over-year as of September 2016, adding just over 2 million net new enrollees since September 2015, with nearly 1.4 million of those added since January 1, 2016.
- The sixteen expansion states listed above have seen Medicaid managed care enrollment increase by more than 1.6 million members, or 5.0 percent, in the past year, at 34.2 million at the end of Q3 2016, up from 32.5 million as of Q3 2015.
- The eight states that have not yet expanded Medicaid have seen Medicaid managed care enrollment increase by more than 380,000 members, roughly 3.1 percent, surpassing 12.7 million at the end of Q3 2016, up from less than 12.4 million as of Q3 2015.
[1] Arizona, California, Florida, Georgia, Hawaii, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, New Mexico, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Washington, West Virginia, Wisconsin.
Table 1 – Monthly MCO Enrollment by State – April 2016 through September 2016
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 seen growth in the second and third quarters of 2016, adding a net 31,400 members. At the end of Q3 2016, Arizona’s MCO enrollment stands at more than 1.59 million, up roughly 5 percent year-over-year.
California
Medicaid Expansion Status: Expanded January 1, 2014
Medi-Cal managed care enrollment data through September 2016 shows an overall trend of enrollment growth, with membership up more than 166,000 over the last six months. As of September 2016, enrollment in managed care is approximately 10.6 million, a 6 percent increase over the previous year.
Florida
Medicaid Expansion Status: Not Expanded
Although not currently electing to expand Medicaid, Florida’s statewide Medicaid managed care program continues to grow. As of September 2016, enrollment is nearing 3.4 million, up 4 percent from a year ago. (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 2016, Georgia Medicaid managed care enrollment stands at more than 1.31 million, down just slightly from a year prior. Georgia has not reported enrollment figures for September 2016 as of publication.
Hawaii
Medicaid Expansion Status: Expanded January 1, 2014
In 2015, Hawaii implemented its integrated Medicaid managed care program, combining QUEST managed Medicaid and QUEST Expanded Access, which provides managed Medicaid to the aged, blind, and disabled populations. Through June 2016, enrollment in the new program stands at more than 350,000, up 5 percent from Q2 2015. Hawaii has not reported Q3 2016 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 more than 2.1 million as of September 2016, up just slightly year-over-year. In the third quarter of 2016, Illinois began enrolling dual eligible members who opt out of the duals demonstration in mandatory Managed Long Term Supports and Services (MLTSS) in the Greater Chicago region.
Indiana
Medicaid Expansion Status: Expanded in 2015 through HIP 2.0
As of September 2016, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—has surpassed 1.1 million, up 8.7 percent from the prior year. Indiana managed care plans added more than 24,000 members in the past six months.
Kentucky
Medicaid Expansion Status: Expanded January 1, 2014
As of September 2016, Kentucky enrolled more than 1.2 million beneficiaries in risk-based managed care. Total enrollment is down just over 1 percent from a year prior.
Louisiana
Medicaid Expansion Status: Expanded July 1, 2016
Medicaid managed care enrollment in Bayou Health stands at more than 1.35 million as of September 2016, up 39 percent from the previous year. Louisiana recently authorized Medicaid expansion, with an effective enrollment date that began on July 1, 2016.
Maryland
Medicaid Expansion Status: Expanded January 1, 2014
Medicaid managed care enrollment declined in Maryland throughout 2015, and then reversed course in 2016. Month-over-month enrollment increases have continued through Q3, with September 2016 enrollment coming in at more than 1.1 million, up 12.5 percent from the prior year.
Michigan
Medicaid Expansion Status: Expanded April 1, 2014
Michigan’s Medicaid and CHIP managed care growth trends over the past year have continued, despite two months of negative growth in July and August. As of September 2016, managed care enrollment has surpassed 1.7 million, up 5.2 percent from the previous year.
Minnesota
Medicaid Expansion Status: Expanded January 1, 2014
As of September 2016, enrollment across Minnesota’s multiple managed Medicaid programs sits at more than 934,000, up 17.6 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 six months have reversed some of this growth. Medicaid managed care membership stands at more than 491,000 as of September 2016, down just slightly from last year.
Missouri
Medicaid Expansion Status: Not Expanded
Missouri managed care enrollment in the Medicaid and CHIP programs sits at more than 517,000 as of September 2016. Although the state has not expanded Medicaid, Missouri has seen steady growth in managed care membership, with the September 2016 enrollment up more than 11 percent from the previous year.
New Mexico
Medicaid Expansion Status: Expanded January 1, 2014
As of September 2016, the state’s Centennial Care program had enrolled more than 683,000 members, with steady enrollment growth throughout 2015 and 2016, a 5.8 percent increase over the prior year.
New York
Medicaid Expansion Status: Expanded January 1, 2014
New York’s Medicaid managed care programs collectively enrolled 4.66 million beneficiaries as of September 2016, down 3.1 percent from the previous year. After positive enrollment growth throughout 2015, the first nine months of 2016 have seen a trend of declining enrollment.
Ohio
Medicaid Expansion Status: Expanded January 1, 2014
Ohio’s Medicaid managed care enrollment has seen significant growth in the past two years, due to Medicaid expansion (“Group 8” enrollees) and the launch of MyCare Ohio, the state’s dual eligible financial alignment demonstration. As of September 2016, enrollment across all four programs is nearing 2.5 million, up less than 2 percent from the prior year.
Pennsylvania
Medicaid Expansion Status: Expanded as of 2015
At the end of Q3 2016, Pennsylvania’s Medicaid managed care enrollment sits at nearly 2.25 million, up more than 8 percent in the past year.
South Carolina
Medicaid Expansion Status: Not Expanded
After declines in enrollment in 2015, 2016 has been a year of growth in South Carolina. September 2016’s 761,000 members represent 7.9 percent growth in the past year. South Carolina has so far seen only limited enrollment in the state’s duals demonstration program.
Tennessee
Medicaid Expansion Status: Not Expanded
As of September 2016, TennCare managed care enrollment totaled 1.55 million, up 6.3 percent from the prior year. TennCare enrollment has seen an overall trend of growth in the past year, although enrollment declined in both August and September. Despite this, TennCare has added more than 26,000 members in the past six months alone.
Texas
Medicaid Expansion Status: Not Expanded
As of September 2016, Texas managed care enrollment stands at more than 3.9 million across the state’s five managed care programs, roughly flat from last year.
Washington
Medicaid Expansion Status: Expanded January 1, 2014
Washington’s Medicaid managed care enrollment as of September 2016 is nearing 1.6 million. This represents an 8.8 percent increase from the prior year.
West Virginia
Medicaid Expansion Status: Expanded January 1, 2014
As of September 2016, West Virginia’s managed care program enrolls nearly 390,000 members, up 7 percent from September 2015. Enrollment began to grow significantly in September 2015 after a court ruling allowed the state to proceed with plans to expand managed care.
Wisconsin
Medicaid Expansion Status: Not Expanded
Across the state’s three managed care programs, September 2016 enrollment totals nearly 800,000, up 1.4 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 pulls together 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].