“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.” – Bill Gates
The change in Medicaid financing during the last decade is the perfect illustration of this perspective on change from Bill Gates. In 2010, the proportion of the Medicaid population in managed care was 49%. Now, it is 73%. These are the findings from our new report, The 2020 OPEN MINDS Medicaid Managed Care Update: A State-By-State Analysis. Approximately 53.9 million (73%) of the 73.8 million Medicaid beneficiaries are enrolled in an at-risk managed care financing model for health care services. Of the remaining 19.9 million Medicaid beneficiaries, 14.8 million (20%) are enrolled in fee-for-service (FFS) arrangements and 5.2 million (7%) are enrolled in primary care case management (PCCM) systems. Some states, such as Arkansas and Massachusetts, use all three financial arrangements (FFS, PCCM, and managed care) while other states, such as Tennessee and Hawaii, only use managed care. Additionally some states, such as Missouri, allow Medicaid beneficiaries in specific populations to opt-out of a financing model. Many states moved away from FFS or PCCM models to at-risk managed care models for primary and acute care services. As a result, managed care has gradually become the dominant contracting model.
But like much of the U.S. health care system, the landscape and strategy are location-specific. The 10 states with the highest percentage of the Medicaid population in managed care in 2019 were:
- New Hampshire
- New Jersey
- South Carolina
- New Mexico
The landscape continues to evolve. The five states with the largest percentage change in managed care enrollment between 2018 and 2019 were Missouri, New Mexico, Pennsylvania, Kansas, and Arkansas. And, four states that use a managed care model, the District of Columbia, Kentucky, Utah, and West Virginia, plan to add new populations to their Medicaid managed care initiatives.
The District of Columbia announced plans to transition all Medicaid beneficiaries into managed care financing arrangements within the next five years. The state will begin this process in late 2020 and transition 22,000 of the beneficiaries in FFS arrangements into the state’s managed care model (see DHCF Announces Medicaid Program Reforms & Intent To Re-Procure Managed Care Contracts). Kentucky announced that children committed to Department of Juvenile Justice and in Kentucky’s foster care program will be allowed to enroll in managed care under the Supporting Kentucky Youth (SKY) program, which will begin operating in July and provide coverage to approximately 24,000 Medicaid beneficiaries (see Kentucky Medicaid Awards Five Managed Care Contracts; WellCare Awarded Foster Care Specialty Plan and Kentucky Announces Cancellation Of Medicaid Managed Care Contracts; To Be Rebid In January). Under the new Medicaid Expansion, Utah allows Medicaid Expansion adults who live in select regions to enroll in managed care. Finally, West Virginia developed a new managed care program to provide Medicaid benefits to children in foster care and children with serious emotional disturbance (see West Virginia Seeks Specialized Managed Care For Children And Youth). Kentucky and West Virginia’s decision to move children with complex medical needs into the managed care system is intended to improve health care experiences, reduce care costs, and provide better health outcomes (see The Future Of Medicaid Managed Care: Building A Comprehensive Care Solution For The Complex Consumer Population and Managing Care For Complex Consumers: The Importance Of Community Inclusion). Utah’s transition of Medicaid Expansion adults into managed care is intended to improve access to care, affordability of care, and financial security for Medicaid beneficiaries (see Medicaid Expansion Five Years Later – The Strategic Implications). We’ve covered these developments in these 14 “high change” states during the past couple of years:
- Missouri Medicaid To Continue Prospective Payments To 15 CCBHOs
- Arkansas Division Of Children & Family Services: Family First Fits Us
- District Of Columbia Medicaid Managed Care Contracts
- Utah’s Medicaid Expansion: Implementation Toolkit
- West Virginia Governor Proposes Eliminating Developmental Disabilities Waiver Program List
- Provider Shortages And Limited Availability Of Behavioral Health Services In New Mexico’s Medicaid Managed Care
- Pennsylvania Senate Bill 297 ‘Establishing A Joint Legislative, Executive And A Judiciary Commission On The Child Welfare System
- KDADS Transfers Nursing Facilities From Receivership To Mission Health Communities
- West Virginia Awards Aetna Better Health 3.5-Year $200 Million MCO Contract For Foster Care Population
- PursueCare Launches Telehealth Addiction Treatment Programs For Underserved Rural Populations In Kentucky & West Virginia
For an in-depth view of Medicaid managed care enrollment on a state-by-state level, check out our new report, The 2020 OPEN MINDS Medicaid Managed Care Update: A State-By-State Analysis and our state-specific deep dive profiles – State Medicaid System Profiles. And don’t miss these recent resources related to state Medicaid programs in the OPEN MINDS Industry Library:
- 10 Things To Know About Medicaid Managed Care
- Exploring the Growth of Medicaid Managed Care
- CMS Approval For SMI/SED Amendment Demonstration For The Healthy Indiana Plan (HIP) Section 1115 Waiver
- Optum Begins Contract As Maryland’s Public Behavioral Health ASO
- Fitbit & WellCare Georgia Medicaid To Offer Fitbit Devices For Diabetes In 2020
- The Health Plans Have It!
- State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2020 Annual Update
- Colorado Medicaid Offers $10 Incentive For Members To Quit Tobacco
- Virginia DMAS Special: Medicaid Psychiatric Residential Treatment Facilities Rate Study
- Michigan DHHS Proposes Statewide Medicaid Specialty Integrated Plans
And for even more, join us at The 2020 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 13 for the session “Improving Care: Engaging Communities & Providers Is Key To Success In The Complex Consumer Market” with Tonya Copeland, vice president, I/DD Services & Employment & Community First CHOICES, UnitedHealthcare.