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HMA has valued recent opportunities to support public health departments to collaborate with communities working to identify and address root causes and ultimately reduce maternal and infant mortality and racial disparities in birth outcomes in Delaware and Maryland.
In partnership with the Delaware Department of Health and Social Services’ Division of Public Health, HMA is in its fourth year of administering a mini-grant program and providing backbone services to community-based organizations. These entities provide wraparound services and a variety of other supports to pregnant and parenting people and their families, with the goal of improving maternal and infant health and reducing racial disparities. We also lead a collective impact evaluation of the programs, working closely with the participating organizations to help them build their capacity to collect and analyze data, developing interim and annual reports, and providing frequent updates to the Division of Public Health and other stakeholders in the state that are collaborating to improve health and wellbeing. HMA provides fiscal and administrative oversight, coaching and evaluation, and convenes the participating organizations for quarterly learning collaboratives, which have contributed to stronger relationships and collaboration among the mini-grantees. In addition, we are implementing and evaluating a guaranteed basic income program as part of the Social Determinants of Health committee of the Delaware Healthy Maternal Infant Consortium (DHMIC). This project is a long-term commitment to collaborating with community-based organizations to build their capacity to address racial disparities and support their work, which is driven by the needs of the people they serve and know best. Grantees are selected through a streamlined process with low administrative burden, prioritizing community input on needed services. Through a collective impact evaluation, the participating organizations are finding positive effects on the self-reported health and wellbeing of program participants.
Launch of the first cohort of Healthy Women Healthy Babies Zones Mini-grantees in 2019. Photo Credit: Division of Public Health – Delaware Health and Social Services
With the Frederick County, Maryland Health Department, HMA conducted a study in 2022 using a community-based participatory research (CBPR) approach to understand and articulate drivers of maternal and infant health disparities experienced by Black women in Frederick County. In collaboration with the health department and newly formed Community Advisory Board (CAB), we facilitated a series of in-person retreats to: collect, analyze, and share quantitative and qualitative data regarding disparities and the drivers of those disparities with stakeholders; understand the data and the story behind the health disparity numbers; and develop and deploy additional research methods, such as surveys, key informant interviews, and focus groups, to further explore the lived experience of Black Frederick County mothers. This iterative approach to conducting mixed-methods research uses the CBPR framework to ensure sustained and meaningful community engagement from project start to end. HMA also developed a driver diagram to illustrate how the root cause, systemic racism, directly influences other drivers of Black maternal health disparities such as historic disinvestment in Black maternal health, historical trauma navigating healthcare, low social capital, health insurance availability, and a perceived lack of emotional and physical safety in clinical settings. The diagram will be shared with relevant stakeholders and inform next steps.
In our reproductive health-related work, HMA has guided groups through decision-making processes, with transparency and without bias, and we understand the importance of group dynamics. Bringing decades of real-world public policy and community and key stakeholder facilitation experience, HMA collaborates with a variety of stakeholders and community members to develop and implement public policy at the local and state levels, as well as to evaluate these efforts. Our experience ranges from national, state, and county agencies, to private sector and community-based organizations that partner with governments to implement policy. Our team has extensive experience working with and within organizations to facilitate discussions, listen to and build consensus across sectors, develop strategic plans, and bring diverse perspectives together to promote health and wellness for communities.
As part of recognizing Women’s History Month, HMA colleagues reflected on recent work to support maternal and infant health and reduce racial disparities in birth outcomes in collaboration with health departments and communities in Delaware and Maryland. More information on our recent projects supporting reproductive health can be found here.
On January 26, the Centers for Medicare & Medicaid Services (CMS) approved California’s (CA) section 1115 request to cover targeted healthcare services for incarcerated individuals 90 days before release. This historical partial rollback of the Medicaid Inmate Exclusion Policy empowers the CA Department of Health Care Services (DHCS) to collaborate with state agencies, counties, health plans and community-based organizations to create coordinated community reentry services focused on persons transitioning from incarceration to community that provide physical and behavioral healthcare services.
Fourteen states have pending section 1115 demonstration requests to provide specific healthcare services for justice-involved individuals. CMS has indicated it will be issuing guidance on the coverage parameters for healthcare services for individuals transitioning from carceral settings. These efforts allow states, counties, and cities to build coordinated systems of healthcare care to support reentry. Building such systems requires infrastructure development and enhancement, stakeholder engagement, strategic planning, and project and change management across justice partners, health plans, and community-based organizations.
Implementing the services will involve an in-depth understanding of the fundamental healthcare needs of justice-involved individuals, carceral setting healthcare delivery and reentry (transition to the community), and how to operationalize necessary changes to meet program requirements. Additionally, change management, critical stakeholder coordination, infrastructure, and technology development, enhancement, guidance on data-sharing agreements, and health plan involvement will need to be created or adapted to meet the CMS 1115 requirements. Administrators of carceral settings and correctional healthcare providers must coordinate services with community-based organizations and health plans to implement timely, cost-effective, and quality healthcare services to individuals leaving carceral facilities.
States, payors, correctional administrators, and healthcare providers will benefit from understanding the 1115 requirements to stand up this initiative, recommendations to facilitate the 1115 application process, how it intersects with healthcare delivery within a carceral setting and during reentry, and practical strategies for planning and operationalizing the effective delivery and coordination of healthcare services that meet program requirements.
On Thursday, April 6, 2023, HMA held a webinar to help states and other stakeholders understand the section 1115 parameters and provide insight to states, local government, correctional health settings, and providers on how to best plan for implementing such services.
Key experts covered the following topics:
Deep Dive into California’s section 1115 approval and lessons learned from the California application process?
Operationalizing In Reach and Re-entry Programming for Justice-Involved Individuals
Understanding the complex needs of justice-involved individuals.
What investments must states make to implement Medicaid-eligible services for justice-involved individuals?
What role can technology and digital health play in supplementing direct care?
The Role of Payers in new Services for Justice-Involved Individuals
HMA consultants bring unparalleled expertise in Medicaid policy, correctional health and a deep understanding of the unique needs of this population. We have the operational knowledge and experience with technology and digital health solutions, as well as the needed data and analytic capacity to collect the correct data to drive improvements in equity and access to care.
Systemic health disparities have exposed Los Angeles’ racially and ethnically diverse populations to increased risks of economic hardship, educational underachievement, and housing instability. To better understand this imbalance and drive toward change, the City of Los Angeles (the City), through Community Development Block Grants (CDBG), Community Service Block Grants (CSBG) and General Funds established the FamilySource System (FSS), a place-based program, to address disparities, prevent and alleviate poverty, increase equity, and better coordinate support for these communities. The purpose of the FSS is to provide a myriad of braided social, educational, work and family support services designed to assist low-income families to become more self-sufficient by increasing family income and academic achievement for youth and adults.
HMA Community Strategies conducted this evaluation of the FamilySource System and economic impact study to identify key trends, barriers, and interventions that could better illuminate disparities in Los Angeles and move to greater income, education, and housing equity.
Contributions to this report were made by Charles Robbins, MBA (project director), Megan Beers, PhD, Ryan Maganini, Matthew Ward, and Yamini Narayan.
This webinar was designed to help states and other stakeholders understand the section 1115 parameters and that will provide insight to states, local government, carceral care settings and providers on how to best plan for implementing such services.
Why this is important:
On January 26, the Centers for Medicare & Medicaid Services (CMS) approved California’s (CA) section 1115 request to cover targeted healthcare services for incarcerated individuals 90 days before release. This historical partial rollback of the Medicaid Inmate Exclusion Policy empowers the CA Department of Health Care Services (DHCS) to collaborate with state agencies, counties, and community-based organizations to create coordinated community reentry services focused on persons transitioning from incarceration to community that provide physical and behavioral healthcare services.
Fourteen states have pending section 1115 demonstration requests:
These requests include specific healthcare services for justice-involved individuals. CMS has indicated it will be issuing guidance on the coverage parameters for healthcare services for individuals transitioning from carceral settings. These efforts allow states, counties, and cities to build coordinated systems of healthcare care to support reentry. Building such systems requires infrastructure development and enhancement, stakeholder engagement, strategic planning, and project and change management across justice partners, health plans, and community-based organizations.
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 32 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 32 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2022. This report reflects the most recent data posted. HMA will continue tracking enrollment throughout the eligibility redetermination period. HMA has made the following observations related to the enrollment data shown on Table 1 (below):
The 32 states in this report account for an estimated 71 million Medicaid managed care enrollees as of December 2022. Based on HMA estimates of MCO enrollment in states not covered in this report, we believe that nationwide Medicaid MCO enrollment was likely about 75 million in December 2022. As such, the enrollment data across these 32 states represents approximately 95 percent of all Medicaid MCO enrollment.
Across the 32 states tracked in this report, Medicaid managed care enrollment is up 7.5 percent year-over-year as of December 2022.
All states, besides Mississippi, saw increases in enrollment in December 2022, compared to the previous year, due to the gains from the COVID-19 pandemic. Mississippi Medicaid managed care enrollment fell because the state shifted members to FFS during the public health emergency.
Twenty-three of the 32 states – Arizona, California, District of Columbia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Virginia, Washington, and West Virginia – expanded Medicaid under the Affordable Care Act and have seen increased Medicaid managed care enrollment since expansion.
The 23 expansion states listed above have seen net Medicaid managed care enrollment increase by 3.5 million members, or 7.2 percent, in the past year, to 52.2 million members at the end of 2022.
The nine states that have not yet expanded Medicaid as of December 2022 – Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, and Wisconsin – have seen Medicaid managed care enrollment increase 8.3 percent to 19 million members at the end of 2022.
Table 1 – Monthly MCO Enrollment by State – July 2022 through December 2022
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Arizona
2,069,048
2,079,360
2,095,101
2,106,800
2,116,444
2,127,666
+/- m/m
8,527
10,312
15,741
11,699
9,644
11,222
% y/y
7.6%
0.0%
7.5%
7.4%
7.2%
7.1%
California
12,929,500
13,013,324
13,073,427
13,132,616
13,231,993
13,204,398
+/- m/m
215,506
83,824
60,103
59,189
99,377
(27,595)
% y/y
9.8%
9.9%
9.9%
9.9%
10.2%
9.5%
D.C.
246,957
247,704
248,577
249,617
250,676
+/- m/m
3,223
747
873
1,040
1,059
N/A
% y/y
6.7%
6.7%
6.5%
6.5%
6.4%
Florida
4,385,965
4,432,233
4,465,670
4,502,297
4,537,121
4,581,266
+/- m/m
41,441
46,268
33,437
36,627
34,824
44,145
% y/y
10.9%
10.9%
10.7%
10.7%
10.7%
11.0%
Georgia
1,975,277
1,988,727
2,016,462
2,027,275
2,035,673
+/- m/m
13,117
13,450
N/A
N/A
10,813
8,398
% y/y
9.8%
9.5%
9.0%
8.7%
8.3%
Illinois
2,890,332
2,884,029
2,900,232
2,929,584
2,965,007
3,000,717
+/- m/m
(8,672)
(6,303)
16,203
29,352
35,423
35,710
% y/y
5.1%
4.5%
4.1%
4.4%
5.1%
5.5%
Indiana
1,742,762
1,761,692
1,769,400
1,781,464
1,797,451
1,813,044
+/- m/m
6,906
18,930
7,708
12,064
15,987
15,593
% y/y
11.6%
11.3%
11.0%
10.5%
10.2%
10.3%
Iowa
795,534
799,748
807,296
812,481
814,490
+/- m/m
2,642
4,214
7,548
N/A
N/A
2,009
% y/y
5.9%
5.8%
6.4%
6.0%
6.1%
Kansas
489,309
490,911
492,640
497,257
499,143
500,814
+/- m/m
2,691
1,602
1,729
4,617
1,886
1,671
% y/y
N/A
N/A
N/A
N/A
8.3%
6.3%
Kentucky
1,494,068
1,487,387
1,509,274
1,518,906
1,528,484
1,534,657
+/- m/m
6,069
(6,681)
21,887
9,632
9,578
6,173
% y/y
5.5%
5.3%
5.6%
5.8%
6.7%
6.1%
Louisiana
1,821,644
1,828,015
1,833,457
1,841,693
1,858,092
1,860,170
+/- m/m
7,213
6,371
5,442
8,236
16,399
2,078
% y/y
4.6%
4.5%
4.4%
4.7%
5.2%
5.8%
Maryland
1,496,677
1,502,271
1,508,469
1,514,381
1,521,171
1,529,308
+/- m/m
8,205
5,594
6,198
5,912
6,790
8,137
% y/y
6.5%
6.2%
6.1%
5.8%
5.8%
5.7%
Michigan
2,280,243
2,294,432
2,299,913
2,309,913
2,319,951
2,324,046
+/- m/m
2,923
14,189
5,481
10,000
10,038
4,095
% y/y
3.8%
3.6%
3.5%
3.7%
4.5%
4.3%
Minnesota
1,261,112
1,262,073
1,278,954
1,286,890
1,293,858
1,299,194
+/- m/m
1,893
961
16,881
7,936
6,968
5,336
% y/y
7.3%
6.7%
7.4%
7.5%
7.5%
7.5%
Mississippi
367,137
363,387
364,612
355,694
367,902
396,880
+/- m/m
(452)
(3,750)
1,225
(8,918)
12,208
28,978
% y/y
-22.7%
-19.9%
-17.4%
-17.3%
-12.5%
-3.9%
Missouri
1,038,239
1,065,217
1,099,707
1,118,373
1,136,589
1,157,005
+/- m/m
26,520
26,978
34,490
18,666
18,216
20,416
% y/y
27.0%
29.1%
32.6%
31.7%
31.8%
29.0%
Nebraska
363,328
366,202
369,770
372,613
374,857
378,237
+/- m/m
2,740
2,874
3,568
2,843
2,244
3,380
% y/y
12.4%
11.9%
11.7%
11.2%
10.8%
10.6%
Nevada
687,362
689,139
697,752
675,465
685,736
692,890
+/- m/m
9,464
1,777
8,613
(22,287)
10,271
7,154
% y/y
9.3%
9.0%
9.3%
4.2%
5.2%
5.7%
New Jersey
2,100,947
2,113,930
2,125,181
2,130,868
2,144,514
2,158,966
+/- m/m
10,897
12,983
11,251
5,687
13,646
14,452
% y/y
7.4%
7.4%
7.2%
7.0%
7.1%
7.0%
New Mexico
809,991
811,732
812,995
813,630
814,466
815,798
+/- m/m
2,491
1,741
1,263
635
836
1,332
% y/y
4.2%
3.7%
3.4%
3.0%
2.6%
2.3%
New York
5,855,615
5,853,108
5,878,519
5,906,264
5,929,288
5,961,782
+/- m/m
39,970
(2,507)
25,411
27,745
23,024
32,494
% y/y
4.5%
4.3%
4.2%
4.3%
4.5%
4.6%
North Carolina
1,738,545
1,746,948
1,757,503
1,768,974
1,778,199
1,837,423
+/- m/m
9,047
8,403
10,555
11,471
9,225
59,224
% y/y
8.0%
6.8%
6.7%
6.6%
6.6%
9.5%
Ohio
2,964,731
2,963,616
2,960,922
2,958,666
2,961,983
2,973,763
+/- m/m
(1,340)
(1,115)
(2,694)
(2,256)
3,317
11,780
% y/y
3.4%
2.6%
1.9%
1.4%
1.0%
0.9%
Oregon
1,193,358
1,202,198
1,206,520
1,211,099
1,221,435
1,228,054
+/- m/m
3,920
8,840
4,322
4,579
10,336
6,619
% y/y
8.3%
8.4%
7.7%
7.6%
7.4%
7.2%
Pennsylvania
2,895,837
2,909,985
2,920,584
2,937,049
2,950,613
2,966,207
+/- m/m
13,973
14,148
10,599
16,465
13,564
15,594
% y/y
7.4%
7.3%
6.9%
6.8%
6.6%
6.5%
South Carolina
1,055,785
1,063,445
1,069,569
1,078,094
1,084,529
1,089,577
+/- m/m
5,226
7,660
6,124
8,525
6,435
5,048
% y/y
7.6%
7.5%
7.4%
7.9%
7.6%
7.5%
Tennessee
1,692,395
1,704,398
1,710,125
1,718,539
1,726,603
1,734,108
+/- m/m
6,737
12,003
5,727
8,414
8,064
7,505
% y/y
6.0%
6.1%
6.1%
6.0%
5.9%
5.8%
Texas
5,466,045
5,653,169
+/- m/m
N/A
N/A
N/A
N/A
N/A
N/A
% y/y
8.6%
10.6%
Virginia
1,572,923
1,582,973
1,589,722
1,598,875
1,608,840
1,619,311
+/- m/m
11,829
10,050
6,749
9,153
9,965
10,471
% y/y
11.3%
11.0%
10.0%
9.6%
10.1%
9.8%
Washington
1,884,734
1,898,983
1,904,127
1,913,230
1,927,690
1,959,278
+/- m/m
8,867
14,249
5,144
9,103
14,460
31,588
% y/y
#DIV/0!
#DIV/0!
5.8%
5.9%
6.0%
7.2%
West Virginia
519,992
524,042
524,922
527,226
530,494
533,194
+/- m/m
2,871
4,050
880
2,304
3,268
2,700
% y/y
6.5%
6.8%
6.4%
5.9%
5.9%
5.7%
Wisconsin
1,161,202
1,166,208
1,172,719
1,179,204
1,184,899
1,190,673
+/- m/m
5,263
5,006
6,511
6,485
5,695
5,774
% y/y
7.5%
7.2%
7.1%
7.1%
6.9%
6.6%
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 Medicaid managed care 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 grew to 2.1 million in December 2022, up 7.1 percent from December 2021.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Acute Care
2,002,584
2,012,802
2,028,335
2,039,880
2,049,311
2,060,376
ALTCS
66,464
66,558
66,766
66,920
67,133
67,290
Total Arizona
2,069,048
2,079,360
2,095,101
2,106,800
2,116,444
2,127,666
+/- m/m
8,527
10,312
15,741
11,699
9,644
11,222
% y/y
7.6%
7.5%
7.4%
7.2%
7.1%
California
Medicaid Expansion Status: Expanded January 1, 2014
Medi-Cal managed care enrollment was up 9.5 percent year-over-year to 13.2 million, as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Two-Plan Counties
8,356,137
8,409,817
8,446,514
8,481,885
8,548,096
8,588,418
Imperial/San Benito
100,384
101,117
101,633
102,064
102,881
103,437
Regional Model
364,066
366,437
368,624
370,361
373,402
375,473
GMC Counties
1,435,250
1,445,532
1,452,127
1,458,149
1,470,122
1,391,421
COHS Counties
2,561,831
2,578,747
2,593,003
2,608,731
2,625,795
2,634,112
Duals Demonstration
111,832
111,674
111,526
111,426
111,697
111,537
Total California
12,929,500
13,013,324
13,073,427
13,132,616
13,231,993
13,204,398
+/- m/m
215,506
83,824
60,103
59,189
99,377
(27,595)
% y/y
9.8%
9.9%
9.9%
9.9%
10.2%
9.5%
District of Columbia
Medicaid Expansion Status: Expanded January 1, 2014
Medicaid managed care enrollment in the District of Columbia was up 6.4 percent to almost 251,000 in November 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Total District of Columbia
246,957
247,704
248,577
249,617
250,676
+/- m/m
3,223
747
873
1,040
1,059
% y/y
6.7%
6.7%
6.5%
6.5%
6.4%
Florida
Medicaid Expansion Status: Not Expanded
Florida’s statewide Medicaid managed care program had seen an 11 percent rise in total covered lives over the last year to nearly 4.6 million beneficiaries as of December 2022. (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).
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
MMA
3,908,539
3,948,929
3,978,098
4,010,534
4,041,816
4,080,381
LTC (Subset of MMA)
124,107
124,691
125,397
126,144
126,720
126,621
SMMC Specialty Plan
332,179
338,057
342,325
346,516
350,058
355,638
FL Healthy Kids
145,247
145,247
145,247
145,247
145,247
145,247
Total Florida
4,385,965
4,432,233
4,465,670
4,502,297
4,537,121
4,581,266
+/- m/m
41,441
46,268
33,437
36,627
34,824
44,145
% y/y
10.9%
10.9%
10.7%
10.7%
10.7%
11.0%
Georgia
Medicaid Expansion Status: Not Expanded
As of December 2022, Georgia’s Medicaid managed care program covered more than 2 million members, up 8.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Georgia
1,975,277
1,988,727
2,016,462
2,027,275
2,035,673
+/- m/m
13,117
13,450
10,813
8,398
% y/y
9.8%
9.5%
9.0%
8.7%
8.3%
Illinois
Medicaid Expansion Status: Expanded January 1, 2014
Illinois enrollment across the state’s managed care programs was up 5.5 percent to 3 million as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
HealthChoice
2,800,420
2,793,124
2,809,689
2,839,342
2,874,700
2,909,303
Duals Demonstration
89,912
90,905
90,543
90,242
90,307
91,414
Total Illinois
2,890,332
2,884,029
2,900,232
2,929,584
2,965,007
3,000,717
+/- m/m
(8,672)
(6,303)
16,203
29,352
35,423
35,710
% y/y
5.1%
4.5%
4.1%
4.4%
5.1%
5.5%
Indiana
Medicaid Expansion Status: Expanded in 2015 through HIP 2.0
As of December 2022, enrollment in Indiana’s managed care programs—Hoosier Healthwise, Hoosier Care Connect, and Healthy Indiana Program (HIP)—was more than 1.8 million, up 10.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Hoosier Healthwise
845,910
852,904
857,952
863,973
869,613
876,606
Hoosier Care Connect
102,805
102,819
102,537
102,253
102,200
102,150
HIP
794,047
805,969
808,911
815,238
825,638
834,288
Indiana Total
1,742,762
1,761,692
1,769,400
1,781,464
1,797,451
1,813,044
+/- m/m
6,906
18,930
7,708
12,064
15,987
15,593
% y/y
11.6%
11.3%
11.0%
10.5%
10.2%
10.3%
Iowa
Medicaid Expansion Status: Expanded January 1, 2014
Iowa launched its statewide Medicaid managed care program in April of 2016. Enrollment across all populations was nearly 814,500, as of December 2022. Enrollment was up 6.1 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Traditional Medicaid
507,266
510,618
516,556
520,234
521,118
Iowa Wellness Plan
237,910
239,261
242,555
244,724
246,385
hawk-i
50,358
49,869
48,185
47,523
46,987
Total Iowa
795,534
799,748
807,296
812,481
814,490
+/- m/m
2,642
4,214
7,548
2,009
% y/y
5.9%
5.8%
6.4%
6.0%
6.1%
Kansas
Medicaid Expansion Status: Not Expanded
Kansas Medicaid managed care enrollment was nearly 501,000 as of December 2022, up 6.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Kansas
489,309
490,911
492,640
497,257
499,143
500,814
+/- m/m
2,691
1,602
1,729
4,617
1,886
1,671
% y/y
8.3%
6.3%
Kentucky
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, Kentucky covered more than 1.5 million beneficiaries in risk-based managed care. Total enrollment was up 6.1 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Kentucky
1,494,068
1,487,387
1,509,274
1,518,906
1,528,484
1,534,657
+/- m/m
6,069
(6,681)
21,887
9,632
9,578
6,173
% y/y
5.5%
5.3%
5.6%
5.8%
6.7%
6.1%
Louisiana
Medicaid Expansion Status: Expanded July 1, 2016
Medicaid managed care enrollment in Louisiana was more than 1.86 million as of December 2022, up 5.8 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Louisiana
1,821,644
1,828,015
1,833,457
1,841,693
1,858,092
1,860,170
+/- m/m
7,213
6,371
5,442
8,236
16,399
2,078
% y/y
4.6%
4.5%
4.4%
4.7%
5.2%
5.8%
Maryland
Medicaid Expansion Status: Expanded January 1, 2014
Maryland’s Medicaid managed care program covered more than 1.5 million lives as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Maryland
1,496,677
1,502,271
1,508,469
1,514,381
1,521,171
1,529,308
+/- m/m
8,205
5,594
6,198
5,912
6,790
8,137
% y/y
6.5%
6.2%
6.1%
5.8%
5.8%
5.7%
Michigan
Medicaid Expansion Status: Expanded April 1, 2014
As of December 2022, Michigan’s Medicaid managed care was up 4.3 percent to 2.3 million.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Medicaid
2,239,937
2,251,810
2,256,800
2,265,219
2,274,763
2,279,473
MI Health Link (Duals)
40,306
42,622
43,113
44,694
45,188
44,573
Total Michigan
2,280,243
2,294,432
2,299,913
2,309,913
2,319,951
2,324,046
+/- m/m
2,923
14,189
5,481
10,000
10,038
4,095
% y/y
3.8%
3.6%
3.5%
3.7%
4.5%
4.3%
Minnesota
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, enrollment across Minnesota’s multiple managed Medicaid programs was nearly 1.3 million, up 7.5 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Parents/Kids
748,197
748,513
758,100
763,044
767,798
770,918
Expansion Adults
272,666
273,387
278,421
281,284
284,073
288,680
Senior Care Plus
24,190
24,252
25,344
25,914
26,415
26,740
Senior Health Options
43,429
43,686
43,920
44,162
44,248
44,324
Special Needs BasicCare
64,656
64,484
65,562
65,763
65,987
66,171
Moving Home Minnesota
11
11
10
10
9
11
Minnesota Care
107,963
107,740
107,597
106,713
105,328
102,350
Total Minnesota
1,261,112
1,262,073
1,278,954
1,286,890
1,293,858
1,299,194
+/- m/m
1,893
961
16,881
7,936
6,968
5,336
% y/y
7.3%
6.7%
7.4%
7.5%
7.5%
7.5%
Mississippi
Medicaid Expansion Status: Not Expanded
MississippiCAN, the state’s Medicaid managed care program, had membership down 3.9 percent to nearly 397,000 as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Mississippi
367,137
363,387
364,612
355,694
367,902
396,880
+/- m/m
(452)
(3,750)
1,225
(8,918)
12,208
28,978
% y/y
-22.7%
-19.9%
-17.4%
-17.3%
-12.5%
-3.9%
Missouri
Medicaid Expansion Status: Expansion Enrollment began in October 2021
Missouri managed care enrollment in the Medicaid and CHIP programs was nearly 1.2 million in December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Medicaid
758,928
757,312
769,419
775,076
782,863
787,611
Total CHIP
28,949
28,937
29,026
29,121
29,231
29,402
Total AEG
199,963
228,361
250,131
262,612
272,574
287,692
Total SHK
50,399
50,607
51,131
51,564
51,921
52,300
Total Missouri
1,038,239
1,065,217
1,099,707
1,118,373
1,136,589
1,157,005
+/- m/m
26,520
26,978
34,490
18,666
18,216
20,416
% y/y
27.0%
29.1%
32.6%
31.7%
31.8%
29.0%
Nebraska
Medicaid Expansion Status: Expanded October 1, 2020
As of December 2022, Nebraska’s Medicaid managed care program enrolled 378,000 members, up 10.6 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Nebraska
363,328
366,202
369,770
372,613
374,857
378,237
+/- m/m
2,740
2,874
3,568
2,843
2,244
3,380
% y/y
12.4%
11.9%
11.7%
11.2%
10.8%
10.6%
Nevada
Medicaid Expansion Status: Expanded January 1, 2014
Nevada’s Medicaid managed care enrollment was up 5.7 percent to nearly 693,000 as of December 2022.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Nevada
687,362
689,139
697,752
675,465
685,736
692,890
+/- m/m
9,464
1,777
8,613
(22,287)
10,271
7,154
% y/y
9.3%
9.0%
9.3%
4.2%
5.2%
5.7%
New Jersey
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, New Jersey Medicaid managed care enrollment was up 7 percent to nearly 2.2 million.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total New Jersey
2,100,947
2,113,930
2,125,181
2,130,868
2,144,514
2,158,966
+/- m/m
10,897
12,983
11,251
5,687
13,646
14,452
% y/y
7.4%
7.4%
7.2%
7.0%
7.1%
7.0%
New Mexico
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, New Mexico’s Centennial Care program covered nearly 816,000 members, up 2.3 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total New Mexico
809,991
811,732
812,995
813,630
814,466
815,798
+/- m/m
2,491
1,741
1,263
635
836
1,332
% y/y
4.2%
3.7%
3.4%
3.0%
2.6%
2.3%
New York
Medicaid Expansion Status: Expanded January 1, 2014
New York’s Medicaid managed care programs collectively covered nearly 6 million beneficiaries as of December 2022, a 4.6 percent increase from the previous year. The Medicaid Advantage program ended in December 2021.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Mainstream MCOs
5,399,089
5,395,489
5,418,915
5,446,409
5,467,467
5,494,358
Managed LTC
255,999
256,538
258,236
257,360
260,087
264,965
Medicaid Advantage
0
0
0
0
0
0
Medicaid Advantage Plus
34,357
34,355
34,689
34,764
34,717
35,061
HARP
164,514
165,067
165,024
166,063
165,340
165,713
FIDA-IDD (Duals)
1,656
1,659
1,655
1,668
1,677
1,685
Total New York
5,855,615
5,853,108
5,878,519
5,906,264
5,929,288
5,961,782
+/- m/m
39,970
(2,507)
25,411
27,745
23,024
32,494
% y/y
4.5%
4.3%
4.2%
4.3%
4.5%
4.6%
North Carolina
Medicaid Expansion Status: Not Expanded
As of December 2022, enrollment in North Carolina’s Medicaid managed care program was 1.8 million, up 9.5 percent from the prior year. North Carolina implemented Medicaid managed care on July 1, 2021.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total North Carolina
1,738,545
1,746,948
1,757,503
1,768,974
1,778,199
1,837,423
+/- m/m
9,047
8,403
10,555
11,471
9,225
59,224
% y/y
8.0%
6.8%
6.7%
6.6%
6.6%
9.5%
Ohio
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, enrollment across all four Ohio Medicaid managed care programs was nearly 3 million, up 0.9 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
CFC Program
1,800,781
1,800,038
1,798,135
1,796,327
1,798,873
1,804,860
ABD/Duals
348,071
348,176
347,461
347,371
347,473
347,839
Group 8 (Expansion)
815,879
815,402
815,326
814,968
815,637
821,064
Total Ohio
2,964,731
2,963,616
2,960,922
2,958,666
2,961,983
2,973,763
+/- m/m
(1,340)
(1,115)
(2,694)
(2,256)
3,317
11,780
% y/y
3.4%
2.6%
1.9%
1.4%
1.0%
0.9%
Oregon
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, enrollment in the Oregon Coordinated Care Organization (CCO) Medicaid managed care program was more than 1.2 million, up 7.2 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Oregon
1,193,358
1,202,198
1,206,520
1,211,099
1,221,435
1,228,054
+/- m/m
3,920
8,840
4,322
4,579
10,336
6,619
% y/y
8.3%
8.4%
7.7%
7.6%
7.4%
7.2%
Pennsylvania
Medicaid Expansion Status: Expanded January 1, 2015
As of December 2022, Pennsylvania’s Medicaid managed care enrollment was nearly 3 million, up 6.5 percent in the past year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Pennsylvania
2,895,837
2,909,985
2,920,584
2,937,049
2,950,613
2,966,207
+/- m/m
13,973
14,148
10,599
16,465
13,564
15,594
% y/y
7.4%
7.3%
6.9%
6.8%
6.6%
6.5%
South Carolina
Medicaid Expansion Status: Not Expanded
South Carolina’s Medicaid managed care programs collectively enrolled nearly 1.1 million members as of December 2022, which represents an increase of 7.5 percent in the past year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Medicaid
1,041,909
1,049,706
1,056,026
1,064,548
1,071,016
1,076,146
Total Duals Demo
13,876
13,739
13,543
13,546
13,513
13,431
Total South Carolina
1,055,785
1,063,445
1,069,569
1,078,094
1,084,529
1,089,577
+/- m/m
5,226
7,660
6,124
8,525
6,435
5,048
% y/y
7.6%
7.5%
7.4%
7.9%
7.6%
7.5%
Tennessee
Medicaid Expansion Status: Not Expanded
As of December 2022, TennCare managed care enrollment totaled 1.7 million, up 5.8 percent from the prior year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Tennessee
1,692,395
1,704,398
1,710,125
1,718,539
1,726,603
1,734,108
+/- m/m
6,737
12,003
5,727
8,414
8,064
7,505
% y/y
6.0%
6.1%
6.1%
6.0%
5.9%
5.8%
Texas
Medicaid Expansion Status: Not Expanded
Texas’ state fiscal year begins in September and program-specific enrollment is only reported at the end of each state fiscal quarter. As of November 2022, Texas Medicaid managed care enrollment was nearly 5.7 million across the state’s six managed care programs, up 10.6 percent from the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
STAR
4,559,293
4,748,820
STAR+PLUS
559,746
568,456
STAR HEALTH
45,760
46,228
Duals Demo
34,336
33,673
CHIP
97,153
85,773
STAR KIDS
169,757
170,219
Total Texas
5,466,045
5,653,169
+/- m/m
% y/y
8.6%
10.6%
Virginia
Medicaid Expansion Status: January 1, 2019
Virginia Medicaid managed care enrollment was up 9.8 percent in December 2022 to 1.6 million members.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Virginia
1,572,923
1,582,973
1,589,722
1,598,875
1,608,840
1,619,311
+/- m/m
11,829
10,050
6,749
9,153
9,965
10,471
% y/y
11.3%
11.0%
10.0%
9.6%
10.1%
9.8%
Washington
Medicaid Expansion Status: Expanded January 1, 2014
Washington’s Medicaid managed care enrollment increased 7.2 percent to nearly 2 million as of December 2022, compared to the previous year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total Washington
1,884,734
1,898,983
1,904,127
1,913,230
1,927,690
1,959,278
+/- m/m
8,867
14,249
5,144
9,103
14,460
31,588
% y/y
#DIV/0!
#DIV/0!
5.8%
5.9%
6.0%
7.2%
West Virginia
Medicaid Expansion Status: Expanded January 1, 2014
As of December 2022, West Virginia’s Medicaid managed care program covered 533,000 members, up 5.7 percent year-over-year.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
Total West Virginia
519,992
524,042
524,922
527,226
530,494
533,194
+/- m/m
2,871
4,050
880
2,304
3,268
2,700
% y/y
6.5%
6.8%
6.4%
5.9%
5.9%
5.7%
Wisconsin
Medicaid Expansion Status: Not Expanded
Across Wisconsin’s three Medicaid managed care programs, December 2022 enrollment totaled nearly 1.2 million, up 6.6 percent from the year before.
Jul-22
Aug-22
Sep-22
Oct-22
Nov-22
Dec-22
BadgerCare+
1,042,456
1,047,217
1,053,361
1,059,587
1,065,182
1,070,788
SSI
61,841
61,916
62,065
62,129
62,165
62,293
LTC
56,905
57,075
57,293
57,488
57,552
57,592
Total Wisconsin
1,161,202
1,166,208
1,172,719
1,179,204
1,184,899
1,190,673
+/- m/m
5,263
5,006
6,511
6,485
5,695
5,774
% y/y
7.5%
7.2%
7.1%
7.1%
6.9%
6.6%
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.
HMAIS enhances this publicly available information with an overview of the structure of Medicaid in each state, as well as proprietary Medicaid Managed Care RFP calendars.
For additional information on how to subscribe to HMA Information Services, contact Carl Mercurio at 212-575-5929 or [email protected].
[1] Arizona, California, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin.
Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and should, work to improve their Consumer Assessment of Healthcare Providers Systems (CAHPS) scores.
The CAHPS annual survey measures member experience with providers and Medicare and Medicaid health insurance plans. It has also become a critical metric used by the Centers for Medicare and Medicaid Services (CMS).
Plans can work to improve CAHPS scores by developing a comprehensive improvement plan involving a holistic year-around approach that involves monitoring the member experience from enrollment through disenrollment. With score improvement comes incentive payments tied to high quality performance.
CAHPS SCORES ARE USED BY:
The National Committee for Quality Assurance (NCQA) to STAR rate health plans in accreditation scoring
Potential members to compare plan scores against one another on the NCQA website
Several state Medicaid programs that require plans to report these surveys and use scores as part of their incentive programs
CMS, which has increased its STAR rating, CAHPS-related measure from double weighted to quadruple weighted in contract year 2021
Medicare Advantage Prescription Drug (MAPD) plans, which use CAHPS to calculate 32% of the overall aggregate score
CAHPS COHORTS THAT ARE MEDICARE STAR MEASURES
PART C CAHPS MEASURES (WEIGHTS)
Getting needed care (4)
Getting appointment and care quickly (4)
Customer service (4)
Rating of healthcare quality (4)
Rating of health plan (4)
Care coordination (4)
Annual flu vaccine (1)
PART D CAHPS MEASURES (WEIGHTS)
Rating of drug plan (4)
Getting needed prescription drugs (4)
ADDITIONAL STAR MEASURES AND ACTIVITIES THAT RELATE TO MEMBER EXPERIENCE
PART C MEASURES (WEIGHTS)
Complaints about the health plan (2)
Member choosing to leave the plan (2)
Plan makes timely appeals decisions (2)
Reviewing appeal decisions (2)
Call center, language interpreter and TTY availability (2)
Health plan quality improvement (5)
PART D MEASURES (WEIGHTS)
Call center, language interpreter and TTY availability (2)
Appeals auto forwarded (2)
Appeals upheld (2)
Complaints about the drug plan (2)
Member choosing to leave the drug plan (2)
Drug plan quality improvement (5)
Health Management Associates’ expert colleagues can help plans outline an organizational assessment of member experience and customize interventions and solutions to increase scores.
Our team of quality and accreditation experts can help organizations improve customer service and scores by:
Establishing a year-around effort
Using an organizational effort to break down department silos and improve cooperation between departments
Assessing core functions within the plan and contractors that contribute to member experience including marketing, enrollment, disenrollment, UM, QI, member service, grievances, appeals, etc.
Identifying and addressing patient frustrations with providers and plans before they become problematic
Leveraging information technology to make websites more user friendly
Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year
Recognizing social determinants of health (SDOH) are often overlooked in access to care-related issues, such as lack of transportation or lack of funds for co-payments
Outlining techniques for obtaining point-of-service feedback to help address potential member experience issues before they arise
A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
This week, our In Focus section highlights a Wakely, an HMA Company, summary and analysis of the 2024 Medicare Advantage Advance Notice, prepared for America’s Health Insurance Plans (AHIP). The Centers for Medicare & Medicaid Services (CMS) released the contract year (CY) 2024 Advance Notice with an accompanying fact sheet on February 1, 2023. AHIP has retained Wakely Consulting Group to provide a financial impact summary report of the information presented in the notice. Specifically, Wakely was asked to analyze changes to Medicare Advantage (MA) revenue, risk adjustment models, and fee-for-service (FFS) normalization.
Key highlights of the analysis are:
The CY 2024 FFS growth rate is lower than projections from the 2023 Final Announcement. A portion of the downward restatement is driven by a technical change. CMS has not commented on the additional drivers.
Based on a large sample of plans, Wakely estimated that the proposed Part C risk adjustment model is expected to decrease plan risk adjusted payment by 3.7 percent overall, which represents a bigger headwind than the CMS estimated decrease of 3.12 percent. The impacts vary significantly by model segment and geographic region, and for individual plans.
The proposed FFS normalization factor excludes PY 2021 risk scores in the calculation of the underlying trend. The exclusion of PY 2021 increases the FFS normalization factor which decreases PY 2024 risk scores.
The report, released March 6, 2023, provides additional detail and discussion of these issues. For questions, please contact Tim Courtney or Rachel Stewart.
