More and more Blue Cross and Blue Shield plans are renting capabilities or buying companies with Medicaid-specific expertise to compete in the Medicaid space.

Several Blues plans tried to break into Medicaid managed care over a decade ago, yet failed, as “they didn’t appreciate all the adjustments they had to make to succeed in that business,” says Bob Atlas, president of health care strategy consulting firm EBG Advisors.

Now Blues plans are turning to partner on Medicaid with companies like Anthem, Inc. subsidiary Amerigroup Corp. and the AmeriHealth Caritas Family of Companies, rather than develop the infrastructure in-house.

For instance, BlueCross BlueShield of Western New York is using its Amerigroup partnership to expand Medicaid business into Niagara and Genesee counties. Its plan has covered 31,000 members in Child Health Plus and another 28,500 members in Medicaid managed care.

Florida True Health, a joint venture of Florida Blue and AmeriHealth Caritas, serves Medicaid members in 55 of the state’s 67 counties. Blue Shield of California bought Care1st Health Plan in 2015, which has 473,000 Medicaid beneficiaries at the time of acquisition, to foray into California’s Medicaid program.

Yet not all Blues plans that are active in the Medicaid business rely on partnerships. For instance, BlueCross BlueShield of Tennessee has operated in the TennCare Medicaid managed care program for more than two decades. Anthem is also expanding its Medicaid coverage in Wisconsin, becoming the first Medicaid plan that serves the entire state.