Non-public Medicaid well being plans misplaced tens of millions of members previously yr as pandemic protections that prohibited states from dropping anybody from the federal government program expired.
However regardless of Medicaid’s unwinding, because it’s identified, no less than two of the 5 largest publicly traded firms promoting plans have continued to extend income from this system, in keeping with their newest earnings reviews.
“It’s a really attention-grabbing paradox,” mentioned Andy Schneider, a analysis professor at Georgetown College’s McCourt Faculty of Public Coverage, of plans’ Medicaid income growing regardless of enrollment drops.
Medicaid, the state-federal well being program for low-income and disabled individuals, is run by states. However most individuals enrolled in this system get their well being care by way of insurers contracted by states, together with UnitedHealthcare, Centene, and Molina.
The businesses persuaded states to pay them extra money per Medicaid enrollee below the idea that youthful and more healthy individuals had been dropping out — presumably for Obamacare protection or employer-based medical health insurance, or as a result of they didn’t see the necessity to get protection — forsaking an older and sicker inhabitants to cowl, their executives have advised traders.
A number of of the businesses reported that states have made midyear and retrospective modifications of their funds to plans to account for the worsening well being standing of members.
In an earnings name with analysts on April 25, Molina Healthcare CEO Joe Zubretsky mentioned 19 states elevated their cost charges this yr to regulate for sicker Medicaid enrollees. “States have been very responsive,” Zubretsky mentioned. “We couldn’t be extra happy with the best way our state clients have responded to having charges be commensurate with regular price tendencies and tendencies which have been influenced by the acuity shift.”
Well being plans have confronted a lot uncertainty through the Medicaid unwinding, as states started reassessing enrollees’ eligibility and dropping these deemed now not certified or who misplaced protection due to procedural errors. Earlier than the unwinding, plans mentioned they anticipated the general danger profile of their members to go up as a result of these remaining in this system can be sicker.
UnitedHealthcare, Centene, and Molina had Medicaid income will increase starting from 3% to 18% in 2023, in keeping with KFF. The 2 different giant Medicaid insurers, Elevance and CVS Well being, don’t escape Medicaid-specific income.
The Medicaid enrollment of the 5 firms collectively declined by about 10% from the top of March 2023 by way of the top of December 2023, from 44.2 million individuals to 39.9 million, KFF information exhibits.
Within the first quarter of 2024, UnitedHealth’s Medicaid income rose to $20.5 billion, up from $18.8 billion in the identical quarter of 2023.
Molina on April 24 reported almost $7.5 billion in Medicaid income within the first quarter of 2024, up from $6.3 billion in the identical quarter a yr earlier.
On April 26, Centene reported that its Medicaid enrollment fell 18.5% to 13.3 million within the first quarter of 2024 in contrast with the identical interval a yr in the past. The corporate’s Medicaid income dipped 3% to $22.2 billion.
Not like UnitedHealthcare, whose Medicaid enrollment fell to 7.7 million in March 2024 from 8.4 million a yr prior, Molina’s Medicaid enrollment rose within the first quarter of 2024 to five.1 million from 4.8 million in March 2023. Molina’s enrollment bounce final yr was partly a results of its having purchased a Medicaid plan in Wisconsin and gained a brand new Medicaid contract in Iowa, the corporate mentioned in its earnings information launch.
Molina added 1 million members as a result of states had been prohibited from terminating Medicaid protection through the pandemic. The corporate has misplaced 550,000 of these individuals through the unwinding and expects to lose an extra 50,000 by June.
About 90% of Molina Medicaid members have gone by way of the redetermination course of, Zubretsky mentioned.
The company giants additionally offset the enrollment losses by getting extra Medicaid cash from states, which they use to go on larger funds to sure services or suppliers, Schneider mentioned. By holding the cash briefly, the businesses can depend these “directed funds” as income.
Medicaid well being plans had been massive winners through the pandemic after the federal authorities prohibited states from dropping individuals from this system, resulting in a surge in enrollment to about 93 million People.
States made efforts to restrict well being plans’ income by clawing again some funds above sure thresholds, mentioned Elizabeth Hinton, an affiliate director at KFF.
However as soon as the prohibition on dropping Medicaid enrollees was lifted final spring, the plans confronted uncertainty. It was unclear how many individuals would lose protection or when it might occur. For the reason that unwinding started, greater than 20 million individuals have been dropped from the rolls.
Medicaid enrollees’ well being care prices had been decrease through the pandemic, and a few states determined to exclude pandemic-era price information as they thought-about how you can set cost charges for 2024. That offered one more win for the Medicaid well being plans.
Most states are anticipated to finish their Medicaid unwinding processes this yr.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Study extra about KFF.
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