November 19, 2018
Medicaid continues to be the largest health
program in the United States as measured by enrollment. Over the years,
the Affordable Care Act (ACA) and Medicaid expansion have proven to help reduce
the number of uninsured Americans and have also significantly increased member
participation in the Medicaid program; however, second-quarter enrollment
trends have indicated year-over-year declines in Medicaid membership. According
to the Centers for Medicare & Medicaid Services (CMS) Medicaid & CHIP
Enrollment Reports, as of June 2018, total Medicaid and Children’s Health
Insurance Program (CHIP) enrollment was 73.8 million, an approximate 500,000
decrease in covered lives from 74.3 million in June 2017. Despite a
decrease in membership, Medicaid has seen increases in payment rates for health
providers and benefits to members, mostly due to a bustling economy. This
brief provides an overview of the current Medicaid market with insights about
top companies competing in this segment.
Medicaid Expansion
Medicaid expansion has played a significant
role in Medicaid eligibility since ACA implementation in 2014. The
expansion of Medicaid programs under ACA resulted in strong enrollment growth
for health plans and service providers industrywide. More and more states
are considering expanding their Medicaid programs. As of September 2018,
34 states including the District of Columbia implemented ACA Medicaid
expansion, with Maine and Virginia expected to implement in 2019. As of
November 6, 2018, expansion votes were cast and approved in Idaho, Utah and
Nebraska. These states will join Maine and Virginia to expand Medicaid and
bring the future state total for expanded Medicaid to thirty-nine.
Source: Kaiser Family
Foundation 50-state survey of
Medicaid officials conducted by Health Management Associates HMA,
November 2018
Medicaid during a Strong
Economy
In 2018, Medicaid saw a slight dip in
membership. According to Kaiser Family Foundation (KFF),
this change has resulted from a couple of different factors. First, as of
September 2018, a strong economy has led to a record low in unemployment of
3.7%; the lowest since 1969. With an increase in the work force, this has
enabled people to shift from Medicaid coverage to alternative health care
plans. Second, Medicaid has seen a decrease in membership due to states
implementing restrictive policies for Medicaid qualification. For example, in
Arkansas, a work requirement
provision was put in place that resulted in 8,500 individuals
becoming ineligible since June 2018. Similar restrictive policies have
been enacted and proposed elsewhere.
In addition to a decrease in Medicaid
enrollment, many states have seen an increase in Medicaid spending, partially
due to continued increasing prices of drugs and specialty services
offered. Additionally, in 2018, many states for the first time became
responsible to pay a portion of expansion costs. To fund these new costs to the
states, many states have implemented new taxes or increased current taxes
accordingly, along with allotted general fund dollars.
Managed Care
Organizations
Managed Care Organizations (MCOs) are the
primary delivery system for Medicaid in the U.S. Medicaid enrollment in
MCOs continues to rise due in part to ACA Medicaid expansion as more states
move beneficiaries to managed-care plans. According to Health Management
Associates’ (HMA) and the Kaiser Family Foundation’s (KFF) annual
50-state survey report,
as of July 1, 2018, thirty-three states with comprehensive risk-based MCOs
reported 75 percent or more of their Medicaid beneficiaries were enrolled in
MCOs.
Medicaid
Managed Care Enrollment and Market Share
The
best available sources of Medicaid managed care enrollment by company are the
statutory financial statements filed with state regulators, the National
Association of Insurance Commissioners (NAIC) and the California Department of
Managed Health Care CA DMHC. Though not fully representative of all state
Medicaid programs, this data provides a useful means of assessing Medicaid
market share and competition. It is important to keep in mind an additional
24.9 million Medicaid members are enrolled by companies or through funding
arrangements not included in statutory financial data used for this
assessment. This data represents approximately 66% of all Medicaid
beneficiaries enrolled.
|
Leading Medicaid Managed Care
Companies: Membership Trend
|
||||
|
Company
|
2Q17
|
Market Share
|
2Q18
|
Market Share
|
|
Centene
|
6,102,297
|
12%
|
6,127,457
|
12%
|
|
Anthem
|
5,156,737
|
10%
|
5,046,593
|
10%
|
|
UnitedHealth
|
5,118,552
|
10%
|
5,381,455
|
11%
|
|
Molina
|
3,374,077
|
7%
|
3,348,100
|
7%
|
|
WellCare
|
2,375,666
|
5%
|
2,380,700
|
5%
|
|
All Others
|
27,345,384
|
56%
|
27,140,374
|
55%
|
|
Total
|
49,472,713
|
100%
|
49,424,679
|
100%
|
Source: Mark Farrah Associates' Health
Coverage Portal/Statutory Financial Statements
As
of second quarter 2018, total managed Medicaid membership reported through
statutory financial statements was over 49.4 million, according to Mark Farrah
Associates' (MFA) latest Medicaid enrollment statistics from the Health
Coverage Portal™. Out of the top five managed care companies, Anthem and
Molina saw a year-over-year decrease in enrollment, whereas Centene,
UnitedHealth and Wellcare experienced an increase. Total year-over-year managed
Medicaid membership marginally decreased by approximately 48,000; a distinct
difference from the 1.38 million member increase between 2Q16 and 2Q17.
Centene,
the company with the largest book of Medicaid managed care business, commanding
12 percent of the market, had a slight increase in membership, growing to 6.13
million members as of 2Q18. Among the top five managed care plans,
UnitedHealth gained the most members, year over year, with growth of almost
263,000, a 5.1% increase over 2Q17. Anthem’s membership dipped by 2.1% or
110,000. Overall, these top five Medicaid companies control 45% of the total
Medicaid managed care market.
Conclusion
With
each additional year that’s passed under the ACA and with more states
continuing to choose to expand their programs, Medicaid appears to be a
permanent fixture in the future of health care in the United States. Despite a
slight drop in membership due to a rising economy and states refining
requirements, Medicaid continues to expand in overall state participation and
increased funding. Mark Farrah Associates will continue to monitor the Medicaid
market and its changes, along with all other aspects of the health care
industry that impact the market and health insurance carriers.
About Mark Farrah
Associates (MFA)
Mark Farrah Associates
(MFA) is a leading data aggregator and publisher providing health plan market
data and analysis tools for the healthcare industry. Our product
portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare
Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™. For
more information about these products, refer to the informational videos and
brochures available under the Our Products section of the website or call 724-338-4100.
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