Managed Medicaid Enrollment Trends and Market Insights

August 1, 2019

Medicaid in the U.S. continues to be a dominant health insurance program 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 72.9 million as of December 2018 according to Kaiser State Facts Total Monthly Medicaid and CHIP Enrollment.  Additionally, Medicaid enrollment in Managed Care Organizations (MCOs) continues to increase due in part to Medicaid expansion and to states that have broadened their managed care programs to new regions.  Enrollment in managed Medicaid plans increased approximately 1.0 percent as of December 2018, 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.

Medicaid Expansion Updates  

Expansion of Medicaid programs under the ACA has resulted in enrollment gains for health plans, and improvements in health care access and affordability for Medicaid members.  To date, 37 states including the District of Columbia chose to expand their Medicaid programs under the ACA, with Maine being the latest to implement expansion in 2019.  Utah, Idaho and Nebraska have initiated plans to expand but have not yet adopted the expansion.    

Source: Kaiser Family Foundation

https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

A growing number of states are filing Section 1115 demonstration waivers that provide increased flexibility to improve state Medicaid and CHIP programs. According to Kaiser Family Foundation, as of July 9, 2019, there are 40 states with approved waivers.  Waivers have also been proposed in South Carolina, Alabama, South Dakota and Washington D.C., but have not been approved to date. In addition, more and more states are considering Section 1115 waivers that would require work as a condition of eligibility. Please see the image below for the latest overview of the Section 1115 waiver approval status in the United States.

Source: Kaiser Family Foundation

https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/

Managed Care Enrollment and Market Share

Most states rely on risk-based Managed Care Organizations (MCOs) as the primary delivery system for Medicaid in the U.S. Thirty-nine states and the District of Columbia currently have some type of MCO plan in place.  Of the 11 remaining states, North Carolina is currently in its first Open Enrollment period in their transition to an MCO program while Alaska and Arkansas are the latest to report plans to implement MCOs. Alaska is favoring an MCO system with one company as a benefit provider for the state while Arkansas has MCO plans for implementing a multi-provider payment system with Provider-led Arkansas Shared Savings Entities (PASSEs).

The best available sources of Medicaid managed care enrollment by company are the statutory financial statements filed with state regulators and the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care).  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 2018, total managed Medicaid membership reported through statutory financial statements was approximately 49.9 million, according to Mark Farrah Associates' (MFA) latest Medicaid enrollment statistics from the Health Coverage Portal™.  This represents a year-over-year increase of 476,738.  As referenced in the chart above, Anthem and Wellcare gained membership with growth of 258,954 and 29,445, respectively. Among the top five managed care plans, Centene, UnitedHealth and Molina experienced enrollment decreases.  Centene, the company with the largest book of Medicaid managed care business, commanding 12.1 percent of the market, experienced a 38,662 decrease in membership between 4Q17 and 4Q18.  Overall, these top five Medicaid companies control 44.3 percent of the total Medicaid managed care market. 

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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