Blues Plans Compete in North Carolina for Lucrative Medicaid Contracts

by Jane Anderson 

Two Blues-affiliated entities — Anthem, Inc. unit Amerigroup Corp. and a joint effort by Blue Cross and Blue Shield of North Carolina and AmeriHealth Caritas — will compete for chunks of North Carolina’s Medicaid business as the Tar Heel state moves from fee-for-service to managed care.

The state Department of Health and Human Services released a long-anticipated request for proposals (RFP) in August seeking insurers to provide health care to most Medicaid and NC Health Choice (Children’s Health Insurance Program) beneficiaries. The RFP stems from a 2015 law directing the department to move 1.5 million of the state’s Medicaid recipients to private insurers beginning in November 2019.

North Carolina is the largest state in terms of Medicaid expenditures — approximately $13 billion — that has not yet moved to managed care, according to Barclays Capital.

To bid on the program, the North Carolina Blues plan partnered with Anthem, Inc.-owned Amerigroup Partnership Plan, LLC to launch “Healthy Blue,” which will use Amerigroup’s Medicaid expertise plus the North Carolina Blues’ local knowledge.

At the same time, AmeriHealth Caritas, formed in 2011 by Independence Blue Cross and Blue Cross Blue Shield of Michigan, is prepping its own bid for a slice of the North Carolina Medicaid managed care business.

Barclays Capital securities analyst Steven Valiquette says individual plan revenue from fully implemented North Carolina Medicaid contracts could be between $1.5 billion and $2.5 billion.

“Due to the limited number of statewide greenfield opportunities in the pipeline, this RFP is expected to be highly competitive with nearly all publicly traded MCOs expected to bid on the business,” Valiquette wrote. He notes that he considers Centene Corp. well positioned to compete for Medicaid business in North Carolina, since it has a strong presence on the individual exchanges and has partnered with the North Carolina Medical Society to collaborate in its Medicaid bid. 

From Health Plan Weekly

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