Ruybalid said her state doesn’t have large marketing budgets, as the giant insurers do, to educate enrollees about how to stay enrolled. “Our managed-care plans are innovative, and we lean on them to help us through this.” “In Nevada, our managed-care plans are motivated to keep members enrolled,” Sandie Ruybalid, deputy administrator of the Nevada state health department division that oversees Medicaid, told a congressional advisory board in January. The health insurers could help those who lose Medicaid coverage find other sources, such as the government-subsidized plans offered on the ACA marketplaces. State Medicaid officials say they need the health plans’ help during the unwinding to avert a big jump in uninsured residents. So moving members to an ACA plan could boost the profits of these companies. Investor-owned companies earn pretax profit margins of about 3% on average from Medicaid managed care, slightly below what they make on ACA marketplace business, he said. Subscribe to KHN's free Morning Briefing. “It’s billions of dollars for these guys,” he said of the five largest Medicaid health plans: Centene, UnitedHealthcare, Aetna, Elevance Health (formerly Anthem), and Molina Healthcare. The financial ramifications of the so-called Medicaid unwinding for health plans are huge, said Gary Taylor, a securities analyst with Cowen and Co. Of the people losing eligibility, about two-thirds will enroll in a workplace health plan, health insurers predict, and the other third will be evenly divided between ACA plans and being left uninsured. The Biden administration estimates that 15 million of the more than 91 million Medicaid enrollees will fall off the rolls, nearly half because their income exceeds program limits and the rest because they fail to complete the reenrollment paperwork. The plans have a strong financial incentive to keep their members enrolled because states pay them per member, per month: The more people they cover, the more money they get. With states poised to start disenrolling Medicaid enrollees in April who no longer qualify, the insurers hope to retain enrollees who are still eligible and capture those who lose coverage with the Affordable Care Act marketplace plans.Įxcept for the enrollees themselves, for whom losing coverage could restrict access to care and leave them vulnerable to large medical bills, no one has more at stake than these insurers. These plans - many run by insurance titans including UnitedHealthcare, Centene, and Aetna - have seen their revenue surge by billions as their membership soared by millions. It also led to a windfall for the health plans that states pay to oversee care of most Medicaid enrollees. States are trying to reach millions of Medicaid enrollees to make sure those still eligible remain covered and help others find new health insurance. Related story As Pandemic-Era Medicaid Provisions Lapse, Millions Approach a Coverage Cliff
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