Medicare and Medicaid

Datapoint: Wyoming Moves Toward Medicaid Work Requirements

February 28, 2019

A bill that would add work requirements for “able-bodied” adults enrolled in Wyoming’s Medicaid program passed in the state’s House last week. The state has not expanded Medicaid, and serves just 57,084 beneficiaries.

A bill that would add work requirements for “able-bodied” adults enrolled in Wyoming’s Medicaid program passed in the state’s House last week. The state has not expanded Medicaid, and serves just 57,084 beneficiaries.

Source: AIS’s Directory of Health Plans

What Utah’s Move to Restrict Medicaid Expansion May Mean for MCOs

February 28, 2019

In November’s midterm elections, Utah voters approved a ballot initiative to expand Medicaid. Now, though, Utah has passed a law that requires state officials to apply for a waiver that would implement a more limited form of Medicaid expansion, which could make things tricky for the state’s Medicaid managed care organizations.

Utah’s new law directs the state to submit a Section 1115 waiver application that seeks to cover a capped number of nonelderly adults with incomes of up to 100% of the federal poverty level (FPL), rather than at 138% of the FPL under full Medicaid expansion.

By Leslie Small

In November’s midterm elections, Utah voters approved a ballot initiative to expand Medicaid. Now, though, Utah has passed a law that requires state officials to apply for a waiver that would implement a more limited form of Medicaid expansion, which could make things tricky for the state’s Medicaid managed care organizations.

Utah’s new law directs the state to submit a Section 1115 waiver application that seeks to cover a capped number of nonelderly adults with incomes of up to 100% of the federal poverty level (FPL), rather than at 138% of the FPL under full Medicaid expansion.

If CMS doesn’t approve that waiver request, full Medicaid expansion would go into effect, but with some caveats. If that, too, fails to gain federal approval, an unrestricted form of Medicaid expansion would go into effect by July 1, 2020.

“Uncertainty is definitely the first word that comes to mind,” Patricia Boozang, a senior managing director at Manatt Health, tells AIS Health when asked how Utah’s legislation will affect the state’s Medicaid MCOs.

One potential source of that uncertainty is whether Utah’s waiver request will get approved — making it unclear when the state’s Medicaid expansion will occur, she says. And if Utah’s waiver is approved, it could see legal challenges similar to those challenging Kentucky and Arkansas’ work requirements waivers, creating another source of uncertainty, Boozang notes.

“In Kentucky, for instance, they’re really relying on their health plans to implement features of their waiver, and there has been at least two starts and stops” due to litigation, she says.

Datapoint: Minnesota Loses 20% of MA Members

February 27, 2019

Minnesota was the only state to lose Medicare Advantage members following the 2019 Annual Election Period, largely due to the final elimination of Medicare Cost plans. The state lost 21.2% of its MA members, for a current total of 417,729 covered lives. Blue Cross and Blue Shield of Minnesota was hit particularly hard by the loss of Cost plans, losing 127,275 of its MA members since February 2018.

Minnesota was the only state to lose Medicare Advantage members following the 2019 Annual Election Period, largely due to the final elimination of Medicare Cost plans. The state lost 21.2% of its MA members, for a current total of 417,729 covered lives. Blue Cross and Blue Shield of Minnesota was hit particularly hard by the loss of Cost plans, losing 127,275 of its MA members since February 2018.

Source: AIS’s Directory of Health Plans

Datapoint: Kentucky Looks Into Spread Pricing in Medicaid Pharmacy

February 26, 2019

Pharmacy benefit managers cost the state of Kentucky’s Medicaid program $123.5 million in spread pricing, a practice where PBMs pay drugstores a lower price for treatments, while charging their payer clients more, according to a new report from the Kentucky Cabinet of Family Services. Kentucky’s contracted Medicaid managed care plans paid $958 million to its PBMs in 2018. The state currently serves 1,313,361 Medicaid beneficiaries through managed care plans.

Pharmacy benefit managers cost the state of Kentucky’s Medicaid program $123.5 million in spread pricing, a practice where PBMs pay drugstores a lower price for treatments, while charging their payer clients more, according to a new report from the Kentucky Cabinet of Family Services. Kentucky’s contracted Medicaid managed care plans paid $958 million to its PBMs in 2018. The state currently serves 1,313,361 Medicaid beneficiaries through managed care plans.

Source: AIS’s Directory of Health Plans

Datapoint: AEP Boosts Medicare Advantage Penetration

February 25, 2019

Medicare Advantage enrollment is up 6.39% from last year, to 21.9 million lives, following the Medicare Annual Enrollment Period (AEP). UnitedHealthcare was the biggest winner, gaining an additional 575,893 lives since February 2018, an 11.1% boost.

Medicare Advantage enrollment is up 7.3% from last year, to 21.9 million lives, following the Medicare Annual Enrollment Period (AEP). UnitedHealthcare was the biggest winner, gaining an additional 575,893 lives since February 2018, an 11.1% boost.

Source: AIS’s Directory of Health Plans

2019 Annual Election Period Reports Higher Switch Rates in MA Program

February 25, 2019

Final 2019 Annual Election Period results demonstrate continued growth in the Medicare Advantage program, with overall membership climbing 7% from 21.5 million a year ago to 22.6 million. Changes in enrollment this year were likely due to a combination of factors, from the elimination of Medicare Cost plans in certain markets to new supplemental benefits that sweetened the deal for consumers, industry experts observe.

“Nationally it was a big year for Medicare Advantage,” says Cary Badger, principal with HealthScape Advisors. “And what was unique about this year was…a large portion [of the MA growth] was coming from both the group and the individual plans.”

By Lauren Flynn Kelly

Final 2019 Annual Election Period results demonstrate continued growth in the Medicare Advantage program, with overall membership climbing 7% from 21.5 million a year ago to 22.6 million. Changes in enrollment this year were likely due to a combination of factors, from the elimination of Medicare Cost plans in certain markets to new supplemental benefits that sweetened the deal for consumers, industry experts observe.

“Nationally it was a big year for Medicare Advantage,” says Cary Badger, principal with HealthScape Advisors. “And what was unique about this year was…a large portion [of the MA growth] was coming from both the group and the individual plans.”

The February data reflecting enrollments accepted though Jan. 4 also showed year-to-date MA enrollment growth of 4.3%. Securities analyst A.J. Rice noted this was “modestly below” last year’s year-to-date membership increase of 4.9%.

One of the market disruptors was the final phasing out of Medicare Cost plans, which the federal government required insurers to eliminate in counties where two or more MA plans are competing.

Switch rates are also up, and that may be due to the availability of new supplemental benefits.

“The primary driver of switching is usually change, such as changes in the network or coverage and premiums…but now what we’re seeing is that seniors are shopping for better coverage rather than just going to the market to see if they can get a better deal,” remarks Badger.