Medicaid redeterminations are being framed up as "lose of coverage" when in fact it would appear increases in enrollment did not appear to have affected payer mix. TANF and SNAP enrollment indicate a fairly stable environment for people living in poverty and close to it.
It is likely than that this loss of coverage will occur most by women and children that entered the program during pregnancy and childless adults during layoffs of early 2020. Since then most of the 10-15M people that will be removed from the rolls have insurance coverage with their employer or another program.
That dynamic suggests a few things. First, the MCOs have been paid a PMPM without commensurate cost of care. It also suggests, redeterminations and terminations will yield a less attractive risk profile as people who need services remain enrolled.
MA is not likely to help given CNC's poor showing during open enrollment. We are skeptical about the conversion to ACA exchange plans as long as the 16-month special enrollment reduces the urgency to act without a hospital admission.
It sounds like a short case. Were it not for the billions piled up on the Medical Benefits Payable line, it would be, but that can only last so long. Link to replay here w/ timestamps.
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Timestamps: 0.00-2:06 Introduction, Why this time will be different 2:06 - 7:32 Headwinds for CNC: Medicaid Redetermination, Poor Showing In MA & Difficulty w/ Commercial Migrations 7:32 - 16:55 National Trends in Medicaid Enrollment; Growth of Major Eligibility Categories; Modeling Medicaid Enrollment Growth Via Treasury Outlays 16:55 - 20:37 Enrollment in TANF, SNAP and Medicaid Payer Mix Suggest Limited Risk for Bad Debt/Charity Care in Services 20:37 - 31:41 Redetermination Process; Models from Florida and Ohio; Ex Parte Redetermination 31:41 - 36:29 CNC: in Context of National Trends; Applying ASPE Research 36:29- 37:47 Applying Ohio Renewal Model to CNC Enrollment; Reviewing CNC's Performance During Last Redetermination Period 37:47 - 42:06 Shifting Medicaid to Commercial - Not Easy 42:06 - 46:43 Medicare Advantage Not Coming to the Rescue; MA Enrollment Down; PDP Enrollment Up 46:43 - 52:09 Political Problems Could Ensnare the MCOs |
Let me know if you have any questions.
Emily Evans
Managing Director – Health Policy
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