Managed Medicaid Market Trends

June 4, 2020

Medicaid continues to be the dominant health insurance program in the United States as measured by enrollment and remains the largest source of funding for health-related services for people with low income. Total Medicaid and Children’s Health Insurance Program (CHIP) enrollment was over 71 million as of December 2019 according to the Centers for Medicare & Medicaid Services (CMS) Monthly Medicaid & CHIP Application, Eligibility Determination, and Enrollment Reports & Data. Enrollment in managed Medicaid plans decreased approximately 1.8 percent as of December 2019, according to Mark Farrah Associates (MFA) and data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care). This report provides a brief overview of year-over-year managed Medicaid market trends with insights about leading companies that compete in this segment.

Market Share

The best available sources of Medicaid managed care enrollment by company are the statutory financial statements filed with state regulators, the NAIC, and the 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 that an additional 23 million Medicaid members are enrolled by companies or through funding arrangements not included in the statutory financial data used for this assessment.

At year-end 2019, total managed Medicaid membership reported through statutory financial statements was approximately 48.3 million, according to Mark Farrah Associates' latest Medicaid enrollment statistics from the Health Coverage Portal™. This represents a year-over-year decrease of 881,855 members. As referenced in the chart above, Centene, Anthem, and Wellcare gained membership with growths of 258,130 (4.28%), 136,870 (2.54%), and 124,357 (3.63%), respectively. Conversely, UnitedHealth and Molina experienced significant enrollment decreases, with UnitedHealth losing 604,998 (11.57%) and Molina dropping 374,362 (11.84%).

UnitedHealth’s decline in membership can be attributed, in part, to the company’s exit from the Iowa Medicaid market, which cost the company 385,609 members; Molina, lost its New Mexico Medicaid contract, losing 196,201. As a result, Centene, the company with the largest increase in Medicaid membership in 2019, gained a combined 325,721 members in the Iowa and New Mexico markets, both states where it did not previously have a Medicaid presence. Anthem, a company with an established presence of 189,423 Medicaid enrollees in Iowa, nearly doubled its membership to 347,255 by year-end 2019.

Overall, these top five companies maintained a strong market presence during 2019, ending with 47.1% of the total Medicaid managed care market (compared to 47.2% in 2018). Membership among the top five companies experienced an overall decrease of 460,003 (1.98%), while membership across the remainder of the market decreased by 421,852 (1.62%).

Financial Ratios

In addition to market share, financial ratios examining medical expenses and premium revenues, as compared to member months, are reliable performance indicators. This section will examine the top five Medicaid companies, as listed above, from this financial perspective.

The segment leaders experienced increases in both expense and revenue per-member-per-month (PMPM) metrics for 2019, compared to 2018. Wellcare experienced the largest increases in both medical expense (17.24%) and premium revenue (15.96%) PMPM ratios. Molina had the smallest medical expense ratio increase with 3.82%, while Anthem had the smallest premiums PMPM increase with 2.29%. Molina was the only company in 2019 to have a premium increase that was larger than its medical cost increase; all other companies experienced increases to medical expense that outpaced premium growth.

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™, 5500 Employer Health ^PLUS, 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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