Medicaid enrollment has increased significantly over the past year and is the fastest growing health insurance sector, according to preliminary results from the annual research cycle for AIS’s Directory of Health Plans: 2017. With an average increase of 7.5% among the first 20 states to respond to AIS’s annual survey, researchers are discerning some prominent trends that could bode well for insurers in this sector.

A larger proportion of Medicaid eligibles are enrolled in managed Medicaid plans vs. state fee-for-service (FFS) coverage compared to last year. In some states that have both FFS and managed programs, enrollment is up in both programs due to increased eligibility, but increases are more substantial in managed care than in FFS. Even in states with an overall decline in membership, reductions are minimal and are concentrated in the FFS segment.

Medicaid expansion is one explanation for increases in a few states, but many Medicaid expansion programs have been in force for several years, so it is not a factor in year-over-year growth for all expansion states. Numbers are up in several non-expansion states, including those without managed care, and slight decreases are seen in both expansion and non-expansion states.

Across the country, and regardless of political leanings, Medicaid programs are being overhauled to become more efficient. These efforts frequently include pushing the population into privately operated managed care plans. Some states have approved new initiatives that have not yet taken effect, and some states are still in the planning stages of how to revamp their programs, especially as they prepare for potential changes to the federal funding mechanism for Medicaid.

Most States Saw Enrollment Gains

Following is a rundown of the Medicaid changes experienced in 20 states over the last year:

  • Arkansas FFS increased 11% to 943,269 eligibles. The state does not offer Medicaid managed care plans, but did expand Medicaid eligibility in 2014.

  • Alaska increased its FFS eligibility by 22% from last year’s 150,129. The state voted to expand Medicaid in 2016, but has yet to implement any new programs.

  • Arizona FFS increased slightly, and the state’s managed care plans grew by 8%. The state expanded Medicaid in 2014.

  • Florida FFS decreased slightly, while the state’s Medicaid managed care plans increased almost 4% to 3,149,279 members. The state has not expanded Medicaid eligibility, but has taken on several care coordination and managed long-term care efforts.

  • Although the state has consistently voted down Medicaid expansion efforts, Georgia’s managed care enrollment is up 2.19%, offset by a decrease of 29,000 FFS members.

  • Idaho’s FFS Medicaid population increased from 289,731 to 294,154 eligibles, even though the state does not offer Medicaid managed care plans and has voted overwhelmingly against Medicaid expansion.

  • Iowa FFS decreased 28.82%, while enrollment in managed care plans increased from 579,546 to 600,816 as the state completed its first full year of Medicaid expansion. The state began transitioning to full managed care as of April 2016.

  • The biggest Medicaid enrollment dip so far is in Kansas, where FFS is down by almost half and the state’s managed Medicaid plans lost 5% of their members.

  • Kentucky is still mulling over a massive Medicaid overhaul and experienced an increase in both FFS (from 125,828 to 228,082) and managed care enrollment (1,310,493 to 1,579,849) in 2017.

  • Within a year of expanding Medicaid, enrollment in Louisiana’s five Medicaid managed care plans is up 35% to 1,466,469. (FFS data was not yet available at press time.)

  • Maryland FFS decreased to 201,636 eligibles, while enrollment in the state’s Medicaid managed care plans increased 11% to 1,157,159.

  • Enrollment in Michigan’s Medicaid managed care plans increased from 1,683,445 to 1,757,412 members. (FFS data was not yet available at press time.)

  • While not an expansion state, Nebraska in January 2017 launched a new Medicaid delivery system called Heritage Health, which coordinates physical, behavioral and prescription drug programs into a single beneficiary-centered medical home. Enrollment in the state’s two Medicaid managed care plans increased 5% to 465,281 enrollees; however, its FFS eligibles in the state decreased 70% for an overall slight decrease in the number of Nebraskans covered by Medicaid.

  • Enrollment in New Mexico’s four Medicaid managed care plans is up 5.19% from last year, from 666,204 to 700,810 enrollees. (Compare to fourth-quarter 2013, when the state had 329,787 people enrolled in managed Medicaid plans.) The state expanded Medicaid in 2014. FFS eligibility also increased slightly.

  • New York had an overall decrease of 4% after expanding Medicaid in 2014. The state’s FFS count was down by 13% to 1,722,971 eligibles, and enrollment in managed care programs was also down by a fraction of a percent. The state expanded Medicaid in 2014.

  • Texas increased enrollment in its Medicaid managed care plans 15% to 3,856,475 members. The state launched a new managed CHIP program for children with disabilities, STAR Kids, in November 2016.

  • Utah FFS decreased 10% from 66,698 eligibles. Medicaid managed care plans also experienced a slight decrease (-1.2%) in enrollment, from 261,412 to 258,352 enrollees.

  • Virginia FFS increased very slightly, and the state’s Medicaid managed care plans increased from 751,279 to 785,745 members.

  • West Virginia cut its FFS count by 25%. Enrollment in the state’s four Medicaid managed care plans increased 17%, from 374,969 to 440,100. The state expanded Medicaid in 2014.

  • Wisconsin FFS decreased to 398,648 eligibles, and enrollment in the state’s managed Medicaid programs also decreased, to 750,118, for an overall decrease of 7%.