Question

What has happened to Medicaid managed care enrollment since 2012?

Answer 1

In 2013 ,

• National Medicaid managed care penetration decreased by 1% from 75% in 2012 to 74% in 2013.
• The share of Medicaid enrollees in comprehensive MCOs increased from 56% in 2012 to 58% in 2013 i.e. by 2%.
• 29 states enrolled more than half of their Medicaid beneficiaries in comprehensive MCOs.
• A majority of state Medicaid programs contracted with at least three comprehensive MCOs in 2013
• About 70% of states contracted with at least three comprehensive MCOs.
• Number of states and territories offering comprehensive MCOs state-wide rose from 32 states in 2012 to 37 states.
• Through comprehensive MCOs around 40 states and territories covered behavioural health, prescription drugs, and dental services and only 14 covered long-term services and supports (LTSS) through their comprehensive MCOs.
• There was a growth in the number of states covering LTSS through comprehensive MCOs- from —from 12 states in 2012 to 14 states in 2013.
• The number of states contracting with behavioural health organizations slightly increased since 2012.
• The number of states and territories requiring MCO plans to be accredited increased to 24 states.
• 52% of comprehensive MCO enrollees were enrolled in plans required by the state to be accredited.

In 2014 ,

• Medicaid Enrollment in MCO's increased from 35 million to 43.3 million. i.e by 24%.
• The number of states in which the majority of managed care enrollees are in comprehensive MCOs increased from 12 in 2013 to 18 in 2014, or one third of all states.Now in 18 states, at least 75 percent of Medicaid beneficiaries are enrolled in any type of managed care program were in comprehensive MCOs.
• States enrolled new population groups (low income adults) into comprehensive MCOs.
• Managed LTSS enrolment grew by 175 percent from 2013 to 2014. The number of states with managed LTSS programs rose from 15 states in 2013 to 17 states in 2014.

In 2015 ,

• Medicaid enrollment in comprehensive MCOs increased from 43.3 million in 2014 to 50.9 million in 2015 by 17.5 percent.

• Medicaid beneficiaries enrolled in comprehensive MCOs increased from 60.2 percent in 2014 to 65.4 percent 2015, up. In 34 states at least 50 percent of all Medicaid beneficiaries were enrolled in comprehensive MCOs, up from 31 states in 2014.This implies that States are increasingly relying on comprehensive MCOs to deliver Medicaid.

• About 8.7 percent of all Medicaid beneficiaries were enrolled in PCCMs in 2015, down from about 10 percent in 2014. In contrast, NEMT managed care programs covered 15.6 percent of Medicaid beneficiaries in 2015, an increase from 11.6 percent in 2014. This shows that Use of Primary Care Case Management (PCCM) programs declined while use of Non-Emergency Medical Transportation (NEMT) programs increased.

• More than 10 million low-income adults covered by the ACA Medicaid expansion were enrolled in comprehensive managed care plans. Twenty six of the 29 states that expanded Medicaid to low-income adults by July 2015 used comprehensive MCOs exclusively to provide coverage to low income adults eligible for Medicaid.

• Eighteen states had managed LTSS (MLTSS) programs in operation excluding three states (Ohio, South Carolina, and Virginia) whose only MLTSS programs at that time were Medicare-Medicaid Financial Alignment demonstrations. Except of Tennessee, all states reporting LTSS users among MLTSS enrollees in both years reported an increase in the number of LTSS users from 2014 to 2015. Overall, Managed long-term services and supports (MLTSS) programs experienced growth.

Citation: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/medicaid-managed-care/downloads/2014-medicaid-managed-care-enrollment-report.pdf

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/medicaid-managed-care/downloads/2013-medicaid-managed-care-trends-and-snapshots-2000-2013.pdf

https://www.medicaid.gov/medicaid/managed-care/downloads/enrollment/2015-medicaid-managed-care-enrollment-report.pdf