Non-public Medicaid well being plans misplaced hundreds of thousands of members up to now yr as pandemic protections that prohibited states from dropping anybody from the federal government program expired.
However regardless of Medicaid’s unwinding, because it’s identified, at the very least two of the 5 largest publicly traded firms promoting plans have continued to extend income from this system, in line with their newest earnings experiences.
“It’s a really attention-grabbing paradox,” stated Andy Schneider, a analysis professor at Georgetown College’s McCourt College of Public Coverage, of plans’ Medicaid income growing regardless of enrollment drops.
Medicaid, the state-federal well being program for low-income and disabled folks, is run by states. However most individuals enrolled in this system get their well being care via insurers contracted by states, together with UnitedHealthcare, Centene, and Molina.
The businesses persuaded states to pay them more cash per Medicaid enrollee beneath the idea that youthful and more healthy folks had been dropping out — presumably for Obamacare protection or employer-based medical health insurance, or as a result of they didn’t see the necessity to get protection — forsaking an older and sicker inhabitants to cowl, their executives have advised buyers.
A number of of the businesses reported that states have made midyear and retrospective adjustments of their funds to plans to account for the worsening well being standing of members.
In an earnings name with analysts on April 25, Molina Healthcare CEO Joe Zubretsky stated 19 states elevated their cost charges this yr to regulate for sicker Medicaid enrollees. “States have been very responsive,” Zubretsky stated. “We couldn’t be extra happy with the best way our state clients have responded to having charges be commensurate with regular price tendencies and tendencies which have been influenced by the acuity shift.”
Well being plans have confronted a lot uncertainty through the Medicaid unwinding, as states started reassessing enrollees’ eligibility and dropping these deemed not certified or who misplaced protection due to procedural errors. Earlier than the unwinding, plans stated they anticipated the general threat profile of their members to go up as a result of these remaining in this system can be sicker.
UnitedHealthcare, Centene, and Molina had Medicaid income will increase starting from 3% to 18% in 2023, in line with KFF. The 2 different massive Medicaid insurers, Elevance and CVS Well being, don’t get away Medicaid-specific income.
The Medicaid enrollment of the 5 firms collectively declined by about 10% from the tip of March 2023 via the tip of December 2023, from 44.2 million folks to 39.9 million, KFF information exhibits.
Within the first quarter of 2024, UnitedHealth’s Medicaid income rose to $20.5 billion, up from $18.8 billion in the identical quarter of 2023.
Molina on April 24 reported practically $7.5 billion in Medicaid income within the first quarter of 2024, up from $6.3 billion in the identical quarter a yr earlier.
On April 26, Centene reported that its Medicaid enrollment fell 18.5% to 13.3 million within the first quarter of 2024 in contrast with the identical interval a yr in the past. The corporate’s Medicaid income dipped 3% to $22.2 billion.
In contrast to UnitedHealthcare, whose Medicaid enrollment fell to 7.7 million in March 2024 from 8.4 million a yr prior, Molina’s Medicaid enrollment rose within the first quarter of 2024 to five.1 million from 4.8 million in March 2023. Molina’s enrollment leap final yr was partly a results of its having purchased a Medicaid plan in Wisconsin and gained a brand new Medicaid contract in Iowa, the corporate stated in its earnings information launch.
Molina added 1 million members as a result of states had been prohibited from terminating Medicaid protection through the pandemic. The corporate has misplaced 550,000 of these folks through the unwinding and expects to lose an extra 50,000 by June.
About 90% of Molina Medicaid members have gone via the redetermination course of, Zubretsky stated.
The company giants additionally offset the enrollment losses by getting extra Medicaid cash from states, which they use to move on greater funds to sure amenities or suppliers, Schneider stated. By holding the cash quickly, the businesses can depend these “directed funds” as income.
Medicaid well being plans had been massive winners through the pandemic after the federal authorities prohibited states from dropping folks from this system, resulting in a surge in enrollment to about 93 million People.
States made efforts to restrict well being plans’ income by clawing again some funds above sure thresholds, stated Elizabeth Hinton, an affiliate director at KFF.
However as soon as the prohibition on dropping Medicaid enrollees was lifted final spring, the plans confronted uncertainty. It was unclear how many individuals would lose protection or when it will occur. For the reason that unwinding started, greater than 20 million folks have been dropped from the rolls.
Medicaid enrollees’ well being care prices had been decrease through the pandemic, and a few states determined to exclude pandemic-era price information as they thought-about the way to set cost charges for 2024. That offered yet one more win for the Medicaid well being plans.
Most states are anticipated to finish their Medicaid unwinding processes this yr.