By Lauren Flynn Kelly
The commonwealth of Kentucky said it will select up to five managed care organizations to serve more than 1.2 million Medicaid and CHIP enrollees starting on July 1, 2020. Potentially complicating that process, however, are two recent developments: (1) Evolent Health on May 29 unveiled plans to acquire a 70% interest in struggling incumbent Passport Health Plan, and (2) the RFP calls for interested bidders to support a controversial work requirement program even though it was struck down by a federal court in March.
Five MCOs currently serve the program. They are Aetna Inc., Anthem, Inc., CareSource, Passport Health Plan and WellCare Health Plans, Inc. With nearly 450,718 Medicaid and CHIP enrollees as of April 2019, WellCare has the biggest market share at 35%, according to AIS’s Directory of Health Plans.
“There are five slots with five incumbents and at least a couple of interlopers seeking to enter into the Kentucky market,” weighs in Alex Shekhdar, founder of Sycamore Creek Healthcare Advisors, via email. “Evolent has some history helping to run plans in Florida, but this is really a double-down on Kentucky given their previous exposure through Passport (i.e., extensive master services agreement whereby Evolent was really doing most of the non-clinical work for Passport anyway.)”
The RFP represents more than $7 billion in revenue, according to industry estimates. Proposals are due July 5 and even though a federal judge vacated federal approval of Kentucky HEALTH, which would have imposed work requirements, the document asks interested bidders how they will promote the goals of that program, “including methods for outreaching to and engaging Enrollees to seek community engagement activities and to take a more active role in their health.”
Awards are likely to be announced in the third quarter of 2019.