Medicaid Plans Face Busy Year of Procurements, Waivers

By Judy Packer-Tursman

From a flurry of state Medicaid managed care procurements and Section 1115 waiver activity to more states heading toward Medicaid expansion under the Affordable Care Act (ACA), Medicaid plans face a busy year ahead, experts tell AIS Health. They also cite more business opportunities for plans to better integrate people dually eligible for Medicare and Medicaid, and to address social determinants of health such as housing, transportation and nutritional needs.

"There’s going to be a great deal to watch in the Medicaid managed care space in 2019," says CEO Meg Murray of the Association for Community Affiliated Plans (ACAP). First is Medicaid expansion, with voters in three states last November electing to expand the program, and voters in two other states replacing governors who either obstructed or rolled back expansion efforts.

Rising drug costs also will be a significant issue, she says. "Just today [Jan. 10], California just moved all its Medicaid managed care plans to a state formulary," she says. "It’s California, so other states will sit up and pay attention. Given that Medicaid managed care plans’ pharmacy management efforts have yielded large-scale savings in the past, it’s questionable whether a state formulary is the best pathway to containing cost growth."

Other experts cite states' activities on Medicaid managed care contracting. "We’re entering into a 'warm' bid year where you have perhaps Georgia open for RFP, North Carolina will close its RFP, Minnesota will presumably open an RFP as well as Kentucky [and] perhaps Ohio," says Alex Shekhdar, vice president of policy at Medicaid Health Plans of America. MHPA represents 93 commercial and non-profit plans that serve more than 25 million lives in 39 states and the District of Columbia.

Sandeep Wadhwa, M.D., chief health officer and senior vice president of government programs and market innovation at Solera Health and a former Colorado Medicaid director, also cites significant procurement activity. "On the Medicaid side, to me there’s so much focus on the states dropping RFPs — Louisiana, Minnesota, Hawaii — and I think those are the 'North Carolinas' of 2019," he says.

"In 2018, there was so much focus on North Carolina moving from ASO [administrative services only] to a capitated model," Wadhwa explains. This year, "the interest is in what the states dropping RFPs are looking for in terms of innovation, population health programs and social determinants of health, and how the managed care plans respond….I think states are really looking for the plans to include in their bids a broader set of interventions."

From Health Plan Weekly