April 5, 2023
Medicare Advantage Capitation Rates and Part C and Part D Payment Policies
1297 Results found.
Behavioral health Section 1115 demonstration waivers and extensions
Health Management Associates (HMA) is a national leader in supporting states with the design, development, negotiation and implementation of Section 1115 demonstration waivers and waiver
extensions. HMA has assisted more than 20 Medicaid departments directly with their state plan amendments, waivers, and other demonstration projects – and most recently supported Alaska, Colorado, Delaware, Indiana, Missouri, and Oklahoma.
HMA’s behavioral health team is currently working with multiple Medicaid agencies on the development of substance use disorder (SUD), serious mental illness (SMI), and serious emotional disturbance (SED) specific 1115 waivers.
We pair our behavioral health and Medicaid subject matter experts to support states with:
- Developing and applying for SMI/SED and SUD Section 1115 demonstration waivers.
- Implementing SMI Section 1115 demonstration waivers.
- Providing an assessment of the requirements under the Section 1115 demonstration waiver and Medicaid managed care “in lieu of” authorities, including requirements for average length of stay,
provider oversight, and monitoring, as well as other considerations. - Reviewing managed care contract requirements and providing applicable Medicaid managed care contract language for states that are utilizing “in lieu of” authority to provide reimbursement for inpatient or residential stays in IMDs.
- Technical assistance with developing administrative infrastructure to monitor utilization, including
adherence to length of stay requirements under the waiver and “in lieu of” options. CMS’ SMI Section 1115 demonstration waiver guidance prohibits states from receiving Federal Financial Participation (FFP) for any IMD stays that exceed 60 days. In cases where states do not meet this metric, CMS can reduce this maximum length of stay (LOS) to 45 days or less. HMA understands it is important for states to have utilization management (UM) strategies in place to identify these instances and minimize the state’s financial risk, and can therefore provide examples of state UM strategies, as well as incentives to manage inpatient and residential LOS while maintaining access to medically necessary services. - Supporting design of data capture and reporting functions for meeting wavier requirements.
- Serving as the independent evaluator for approved SUD and/or SMI/SED 1115 waiver demonstrations.
For more information, contact our featured experts below.
Medicaid redeterminations and loss of coverage
Policy crossroads and the end of the public health emergency due to COVID-19
This is part of a three-part series on significant implications of the end of the Public Health Emergency (PHE).
What does your organization need to know?
March 31st marked the end of the COVID-19 Medicaid continuous coverage condition. Most forecasts project between 10-15 million enrollees will lose Medicaid coverage. State Medicaid programs will lose supplemental funding provided for the continuous coverage requirement and begin to transition to normal eligibility operations. Health Management Associates (HMA) and HMA companies can help the full spectrum of stakeholders plan for, adjust to, and administer the changes up to and beyond the 12-month continuous coverage “unwinding” period. The immediate work can serve as a springboard for future improvement initiatives and to respond to federal guidance that is under development to strengthen and streamline eligibility and enrollment processes and improve the experience for consumers.
Who is affected by this change?
- Payers including Medicaid managed care organizations and Qualified Health Plans
- Provider organizations
- Trade associations of Medicaid managed care or provider organizations
- State and local community-based organizations
- State and local governments responsible for administering and overseeing the eligibility processes for Medicaid and other public programs
- Advocacy groups
- Foundations
- Vendors supporting state agencies, health plans and providers
Watch a video presentation about the HMA Coverage Model
What is in the HMA model?
HMA has developed an insurance mix model that projects how the resumption of Medicaid eligibility redeterminations beginning in April 2023 will affect Medicaid enrollment, employer sponsored insurance (ESI), Marketplace coverage, and the uninsured. The model includes enrollment projections for all 50 states and considers the enhanced Marketplace subsidies included in the Inflation Reduction Act (IRA). Approximately 20 million individuals gained coverage during the redetermination freeze and well over 10 million of the approximately 90 million current Medicaid enrollees are at risk for disenrollment. HMA’s model contemplates the variety in state approaches to managing the resumption of eligibility redeterminations as well as key insights related to the differential impact by Medicaid eligibility categories.
HMA can help with immediate needs to help you plan:
- HMA has detailed state-specific unwinding policy insights for each state including observations regarding which states are taking more aggressive and less aggressive approaches.
- We can provide technical assistance and strategic planning services to help states and organizations manage the necessary changes.
- Actuarial experts can assist with acuity changes caused by the change in enrollment.
- Our colleagues are available for a discussion of the product and the key policies influencing the projections.
- HMA can also help with post PHE support.
For more information, please contact our experts below.
Read part 2 in this blog seriesMarch 29, 2023
HMA Community Strategies Conducts Evaluation for the City of Los Angeles FamilySource System
Medicare drug negotiation guidance: what you need to know
This week our In Focus section reviews the Centers for Medicare and Medicaid Services’ (CMS) announcement of initial guidance for the new Medicare Drug Price Negotiation Program for 2026. This initial guidance is one of many steps CMS described in the Medicare Drug Price Negotiation Program timeline for the first year of negotiation.
The Drug Price Negotiation Program was approved as part of the Inflation Reduction Act (IRA) (P.L. 117- 169) in August 2022. As discussed in our previous In Focus, the IRA includes several other policies aimed at addressing cost, affordability and access to prescription drugs within the Medicare program.
The Drug Negotiation Program allows the U.S. Department of Health and Human Services (HHS) to negotiate maximum fair prices (MFPs) for Part D drugs. Negotiations between HHS and prescription drug manufactures will begin in 2023 and continue into 2024 before negotiated prices go into effect Jan. 1, 2026.
For Medicare payment in 2026, HHS can negotiate prices for up to 10 Part D drugs that do not have generic or biosimilar competition. CMS can increase the number of Part D drugs selected for price negotiation each subsequent year. Starting in 2028, the agency can annually add up to 20 new Part B or Part D drugs to the program.
The published guidance describes CMS’ approach for identifying the drugs selected for the initial year of the program. However, CMS is finalizing these policies as announced for the initial drug negotiation year.
The initial guidance also details the requirements and procedures for implementing the process for the first set of negotiations. For example, the guidance details aspects related to the offer-counter-offer exchange process, confidentiality terms following an agreement, penalties for violations, and the dispute resolution process.
Key Considerations
The drug negotiation program presents numerous operational and policy questions for CMS, manufacturers, and the healthcare sector broadly. The program is expected to have a direct impact on prices and affordability for the Medicare program and its beneficiaries. Additionally, other public and commercial payers will want to consider the potential downstream impacts on their costs. Ongoing monitoring of HHS’ implantation of the drug negotiation program and the pharmaceutical industry’s response to the drug negotiation program will help health plans, providers, and other interested stakeholders navigate this new landscape.
What’s Next
In the short-run, CMS will benefit from feedback from stakeholders about the outstanding policy and operational issues the agency has identified. Comments can be submitted until April 14, 2023
CMS anticipates issuing revised guidance for the first year of negotiation in Summer 2023. By September 1, 2023, CMS plans to publish the first 10 Part D drugs selected for the initial program year. The negotiated maximum fair prices for these drugs will be published by September 1, 2024 and prices will be in effect starting January 1, 2026.
HMA and HMA companies will continue to analyze this and subsequent guidance. We have analytical capabilities and expertise to assist with tailored analysis for manufacturers, providers, patient groups, health plans, and other stakeholders. HMA has the ability to model policy impacts of the drug negotiation program, support the drafting of feedback to CMS as the program is designed and implemented, and provide technical assistance in considering how this new program may interact with other Medicare and Medicaid initiatives.
If you have questions about the Drug Negotiation Program or other aspects of the Inflation Reduction Act and how it will affect manufacturers, Medicare providers, Medicaid programs and patients, contact our experts below.
Medicaid authority to build programs for justice-involved individuals
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
See below for our HMA featured speakers.
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.
HMA Community Strategies conducts evaluation for the city of Los Angeles FamilySource System
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.
Webinar replay: Medicaid authority and opportunity to build new programs for justice-involved individuals
This webinar was held on April 6, 2023.
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.
Additional resources:
Medicaid managed care enrollment update – Q4 2022
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.
[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.