Author Archives: Adam Seidl

DC Announces Intent to Award Medicaid Managed Care Contracts, May-17 Opportunity Assessment

Washington, DC, announced in May 2017 its intent to award managed care contracts for its Medicaid and Health Alliance programs to incumbents AmeriHealth Caritas and Trusted Health Plan, as well as new entrant Amerigroup. A third incumbent, MedStar Family Choice, was not awarded a contract. Contracts will be for one year beginning October 2017 with four one-year options. The RFP was released December 2016.

Washington, DC, has been a volatile market for managed care. In 2013, AmeriHealth acquired the assets of Washington’s largest Medicaid plan, DC Chartered Health Plan, which had been placed in receivership by district regulators after certain financial irregularities came to light. UnitedHealth also exited the market in 2013 after heavy losses and a rate dispute with the state. The three plans left are AmeriHealth, MedStar and a startup called Trusted Health. DC is a mandatory managed care jurisdiction. DC operates under a five-year contract cycle that began in 2013.

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Market Overview PDF

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SC Medicaid Managed Care Market Still Competitive

While managed care has been available in South Carolina since 1997, it really began to take off with the state’s launch of Healthy Connections Choices in 2007 and then again when the state completed the transition of its Medical Home Network/Primary Care Case Management (MHN) program into managed care on Jan. 1, 2014. The number of health plans competing has also grown. In anticipation of the conversion, Molina entered the market by acquiring certain assets of Community Health Solutions of America, including the rights to convert Community’s 137,000 MHN members to full-risk managed care effective Jan. 1, 2014. WellCare entered the market in 2013 by buying out UnitedHealth’s Medicaid business in the state. WellCare further expanded its presence through the acquisition of certain assets of another MHN plan Carolina Medical Homes. WellCare also announced a deal to acquire Advicare. Other incumbent Medicaid managed care plans in the market are Select Health/AmeriHealth Caritas, Absolute Total Care/Centene, and BlueChoice/Companion/BCBS-SC. South Carolina isn’t 100% risk-based managed care; total Medicaid membership tops 1 million.

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IL Moves 2 Million Enrollees into Medicaid MCOs

Illinois has converted more than 2 million children, families and aged, blind and disabled members to Medicaid managed care, with passive enrollment beginning in 2014. Prior to the conversion – which began with the elderly and disabled populations and then began enrolling children and families – managed care served less than 10% of the state’s 3 million Medicaid lives in a voluntary program. In conjunction with the conversion to Medicaid managed care, Illinois also contracted with several provider-led Medicaid Accountable Care Entities – in effect providing certain Medicaid eligibles with an alternative to Medicaid managed care plans. ACEs receive a care coordination fee, and providers in the ACE network receive fee-for-service payments. About 470,000 members are enrolled in an ACE. However, the state plans to phase out ACEs or force them to move to full-risk. Members of phased-out ACEs would move into a full-risk Medicaid managed care plans..

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