Medicaid Managed Care Makes Its Presence Known

Medicaid managed care plans have been the main driver of an increase in enrollees, according to a study by PricewaterhouseCoopers. Enrollment in Medicaid managed care plans increased by 3.4 million over the last year. That means the 54.7 million of the 75.2 million Medicaid beneficiaries in the country are enrolled in a privately run health plan.

Of all the ramifications of the ACA, Medicaid expansion “may be the most under-reported and under-discussed,” the study states. The 75 million individuals now covered by Medicaid represents nearly 1 in 4 Americans. In 2013, only 59 million were covered, meaning 1 in 17 citizens have been added to Medicaid programs.

The study predicts that Medicaid will become more consequential, consolidated, and comingled in coming years. That is: “Plans should prepare for greater scrutiny, but also improved opportunities to demonstrate their part in delivering health care value.” There will be “an increased cadence in consolidation as sub-scale plans realize the limited opportunities present to achieve the necessary scale to support investments in administrative overhead and achieve organizational objectives, while a host of roll-up platforms begin to emerge to achieve efficiencies. “ In addition, “by 2025, an estimated 17 million will be enrolled in both Medicare and Medicaid.”

Source: PricewaterhouseCoopers