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This week, our In Focus reviews the Medicare Advantage (MA) and Part D landscape files and quality performance data for the 2020 plan year from the Centers for Medicare & Medicaid Services (CMS). Data on MA and Part D offerings include premiums and benefit design, as well as Star Ratings for each MA contract. This year’s release signals continued growth for the MA program in 2020. The total number of MA plans increased by 403 offerings to 3,144, up from 2,741 in 2019, the highest number since inception of the program. Notably, growth appears to be occurring in parts of the country with existing market saturation, as many MA organizations are offering new plans in states with MA enrollment levels of 30 percent or higher. There is also significant growth in the number of Dual Eligible Special Needs Plans (D-SNPs) offered by MA organizations, particularly among top MA sponsors Humana and CVS (Aetna).

Read More2020 Medicare Advantage, Part D Landscape Files and Quality Performance Data

This week, our In Focus section reviews the Pennsylvania HealthChoices Physical Health Medicaid managed care request for applications (RFA), issued by the Pennsylvania Department of Human Services on October 15, 2019. Medicaid managed care organizations (MCOs) will serve the five HealthChoices zones covering all 67 counties: Southeast, Southwest, Lehigh-Capital, Northwest, and Northeast. Contracts are worth nearly $13 billion.

Read MorePennsylvania Releases HealthChoices Physical Health RFA

This week, our In Focus section reviews the Utah Medicaid Section 1115 Demonstration Waiver amendment Fallback Plan, released for public comment on September 27, 2019. The Fallback Plan would raise Utah’s Medicaid expansion income limit to 138 percent of the federal poverty level (FPL)[1]. Voters in the state passed full Medicaid expansion through a ballot initiative in 2018, however, the state only enacted partial expansion through a waiver. The Fallback Plan looks to fully expand Medicaid, while also implementing certain provisions, including work requirements and premiums.

Read MoreUtah Releases Medicaid Expansion Fall Back Plan Waiver Amendment

This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states.^[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the second quarter (Q2) of 2019. This report reflects the most recent data posted. HMA has made the following observations related to the enrollment data shown on Table 1 (below):

Read MoreMedicaid Managed Care Enrollment Update – Q2 2019

This week, our In Focus section reviews the Medicare Advantage (MA) and Part D landscape files for the 2020 plan year released by the Centers for Medicare & Medicaid Services (CMS) on September 24, 2019. These files include information on MA and Part D offerings, including premiums and benefit design. This year’s release signals continued growth for the MA program in 2020. Nationwide, the number of MA plans continues to increase, with 3,144 offerings, up from 2,741 in 2019.  Among these plans, 2,832 will offer Part D coverage. CMS states that the average monthly plan premium is expected to decrease 14 percent to $23.00 in 2020 down from $26.87 in 2019. According to CMS, this is the lowest average monthly premium since 2007.

Read MorePreliminary Insights on 2020 Medicare Advantage and Part D Plan Offerings

This week, our In Focus section reviews Texas v. United States., the most recent legal challenge to the Affordable Care Act (ACA). In July 2019, the United States Court of Appeals for the 5th Circuit heard oral arguments in the case and is reviewing the decision of United States District Court for the Northern District of Texas (District Court). The District Court ruled that the “individual mandate” provision of the ACA is unconstitutional as a result of the 2017 Tax Cuts and Jobs Act (TCJA) zeroing out of the tax penalty for not having health insurance and, consequently, that the entire ACA should be struck down as a result. As the nation awaits the 5^th Circuit panel’s decision, this article discusses background, next steps in the court process, and the potential far-reaching implications of this case.

Read MoreThe Future of the ACA: Implications of 5th Circuit Decision in Texas v. United States

This week, our In Focus section provides a recap of the fourth annual HMA Conference, The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States are Positioning Themselves for Success, held this Monday, September 9, and Tuesday, September 10, in Chicago, Illinois. Nearly 500 leading executives representing managed care organizations, providers, state and federal government, community-based organizations, and other stakeholders in the health care field gathered to address the challenges and opportunities for organizations serving Medicaid and other vulnerable populations. Conference participants heard from keynote speakers, engaged in panel discussions, and connected during informal networking opportunities. Below is a summary of highlights from this year’s conference.

Read MoreHighlights from this Week’s HMA Conference on The Next Wave of Medicaid Growth and Opportunity

This week, our In Focus section reviews the Hawaii QUEST Integration (QI) Medicaid Managed Care request for proposals (RFP), issued by the Hawaii Department of Human Services (DHS) on August 26, 2019. DHS intends to contract with four health plans. All four will serve Medicaid and Children’s Health Insurance Program (CHIP) members in Oahu, while two will also operate statewide. The two plans with the highest scoring technical proposals will serve beneficiaries statewide. The Quest Integration program is worth $2.2 billion annually.

Read MoreHawaii Releases Quest Integration Medicaid Managed Care RFP