People on the Move

February 15, 2019

North Carolina Awards Much-Anticipated Managed Medicaid Contracts

February 15, 2019

North Carolina this week awarded Medicaid contracts worth an estimated $6 billion per year to five managed care organizations: AmeriHealth Caritas; Blue Cross and Blue Shield of North Carolina; Carolina Complete Health, a provider-led subsidiary of Centene Corp.; UnitedHealthcare; and WellCare Health Plans, Inc. Centene was awarded a regional contract, and can offer plans only in select southern and southwest counties, a surprise to several analysts, while the other four contracts are statewide.

by Carina Belles

North Carolina this week awarded Medicaid contracts worth an estimated $6 billion per year to five managed care organizations: AmeriHealth Caritas; Blue Cross and Blue Shield of North Carolina; Carolina Complete Health, a provider-led subsidiary of Centene Corp.; UnitedHealthcare; and WellCare Health Plans, Inc. Centene was awarded a regional contract, and can offer plans only in select southern and southwest counties, a surprise to several analysts, while the other four contracts are statewide. This is North Carolina’s first foray into managed Medicaid, with the program set to begin in the Raleigh-Durham area in November 2019 (see map below). Eligible members will be able to start selecting plans this summer. David Windley and David Stylbo, analysts at Jefferies LLC, predicted in a Feb. 4 research note that WellCare will benefit most from the contract, estimating a 4% increase in earnings per share. Leerink analyst Ana Gupte in a Feb. 4 research note pointed to potential annual revenue of $2.7 billion per selected insurer.

SOURCE: AIS’s Directory of Health Plans (DHP), The North Carolina Department of Health and Human Services.

Datapoint: Utah Seeks Partial Medicaid Expansion

February 14, 2019

Utah Gov. Gary Herbert on Monday approved a bill that would partially expand Medicaid in the state. The bill also includes work requirements, and an enrollment cap if costs exceed a certain amount. The partial expansion would cover adults living at up to 100% of the poverty level, rather than the traditional expansion level of 138%. This would add about 90,000 people to the state’s current Medicaid population of 288,874 lives. Utah voters approved full Medicaid expansion in the November election, which would have covered up to 150,000 people.

Utah Gov. Gary Herbert on Monday approved a bill that would partially expand Medicaid in the state. The bill also includes work requirements, and an enrollment cap if costs exceed a certain amount. The partial expansion would cover adults living at up to 100% of the poverty level, rather than the traditional expansion level of 138%. This would add about 90,000 people to the state’s current Medicaid population of 288,874 lives. Utah voters approved full Medicaid expansion in the November election, which would have covered up to 150,000 people.

Source: AIS’s Directory of Health Plans

Utah’s Novel Plan For Medicaid Expansion Opens Door To Spending Caps Sought By GOP

February 14, 2019

Utah this week became the 35th state to approve expanding Medicaid under the Affordable Care Act, but advocates for the poor worry its unusual financing could set a dangerous precedent and lead to millions of people losing coverage across the country.

That’s because the plan includes unprecedented annual limits on federal and state spending.

Utah this week became the 35th state to approve expanding Medicaid under the Affordable Care Act, but advocates for the poor worry its unusual financing could set a dangerous precedent and lead to millions of people losing coverage across the country.

That’s because the plan includes unprecedented annual limits on federal and state spending.

Those restrictions would be a radical change for Medicaid. Since it began in 1966, the state-federal health program for low-income residents has been an open-ended entitlement for anyone who meets eligibility criteria. State and federal spending must keep pace with enrollment.

Joan Alker, executive director of the Georgetown University Center for Children and Families, is concerned that the state and federal Medicaid funding caps can limit how many people are enrolled and what services they receive. She said no state has before tried to cap its own funding….

Read the full Kaiser Health News article

Centene CEO Remains Confident in ACA Exchanges

February 14, 2019

Even as some recent headlines have reignited concerns about the long-term prospects of the Affordable Care Act (ACA), Centene Corp. CEO Michael Neidorff told investors that he continues to see more reasons to be optimistic than not.

“It is clear Medicaid and the services we provide are needed more than ever,” Neidorff said during the company’s fourth-quarter earnings call. He also said the most recent ACA marketplace enrollment figures show that “there continues to be consistent demand for affordable, high-quality health care coverage.” As of January, Centene had boosted its paid ACA exchange membership to 2 million, Neidorff said, and it now controls 20% of that market.

By Leslie Small

Even as some recent headlines have reignited concerns about the long-term prospects of the Affordable Care Act (ACA), Centene Corp. CEO Michael Neidorff told investors that he continues to see more reasons to be optimistic than not.

“It is clear Medicaid and the services we provide are needed more than ever,” Neidorff said during the company’s fourth-quarter earnings call. He also said the most recent ACA marketplace enrollment figures show that “there continues to be consistent demand for affordable, high-quality health care coverage.” As of January, Centene had boosted its paid ACA exchange membership to 2 million, Neidorff said, and it now controls 20% of that market.

Though legislative efforts to repeal and replace the ACA are now absent from Congress’ near-term agenda, the latest form of uncertainty comes from a federal judge’s December ruling that the entire law is unconstitutional due to the zeroing-out of the individual mandate.

Neidorff expressed little concern about that development. “We have not been distracted by ACA legal headlines, as we agree with all the legal experts it will be reversed,” he said.

Leerink’s Ana Gupte, though, still had concerns. “While we agree with the CEO view that the TX [Texas] lawsuit decision to overturn the ACA will play out favorably at least in SCOTUS [the Supreme Court], policy uncertainty on this dimension impacts 40%+ of earnings,” she wrote in a research note.