Enrollment in Medicaid Managed Care Grows Faster Than Fee-For-Service

Enrollment in Medicaid Managed Care Grows Faster Than Fee-For-Service

By Rebecca Adams, CQ HealthBeat Associate Editor

The number of Medicaid beneficiaries enrolled through private managed care plans is growing faster than the number of people entering the traditional program, according to an analysis released Wednesday by a trade group representing health plans.

The study, done by the PricewaterhouseCoopers accounting firm for the Medicaid Health Plans of America, found that 9.3 million more Medicaid beneficiaries were in managed care plans in 2014. The number in Medicaid fee-for-service programs fell for the first time, dropping by 300,000 enrollees, according to the report.

The total increase in the number of Medicaid beneficiaries from 2013 to the end of September was about 9 million people, according to the report and federal statistics.

Forty states, up from 37 last year, use private Medicaid plans to deliver services to beneficiaries, according to a presentation on Capitol Hill Wednesday by PwC Health Industries Payer Strategy Director Ari Gottlieb. The jurisdiction with the highest percentage of Medicaid enrollees in managed care is Washington, D.C., followed by New Mexico. The states with the lowest percentage in managed care are Utah, followed by Virginia.

The total number of plans grew from 176 Medicaid plans last year to 184 plans this year, according to Gottlieb. Of those, 166 plans serve just one state. The average number of people in the plans is 134,000 beneficiaries. However, 10 large companies oversee care for more than a million people. The largest Medicaid health plans are UnitedHealthCare, with more than 4.4 million members in 21 states, and Anthem, with 4.3 million members in 17 states. Other companies with a Medicaid population of more than 1 million people include Centene, Molina, WellCare, LA Care, Aetna, HealthNet, Care Source and AmeriHealth Caritas.

“As more states like Tennessee, Indiana, and Utah endorse Medicaid expansion, it only make sense that they do so with the help of Medicaid managed care,” said Jeff Myers, president and CEO of Medicaid Health Plans of America, in a statement. “The risk-based capitated model brings the budget predictability that is key to managing the influx of new Medicaid beneficiaries

Myers had indicated in a talk in early November that 9 million people had joined Medicaid over the past year and that managed care was a growing part of the program. The study provides additional details.

Federal officials are working on a proposed rule that will make changes to policies for Medicaid managed care.