Growing Medicaid MCO Enrollment Provides Opportunities for Payers


As the meaningful data surrounding the mid and long term effects of the COVID-19 crisis begin to come into focus, one aspect of the dramatically impacted healthcare industry is becoming clear: growing Medicaid MCO enrollment. 

While the country remains a patchwork of local and state-led attempts to curtail the spread of the Coronavirus, the widespread economic downturn continues to put upward pressure on unemployment claims. Jobless reports for the end of August still show only one week since March with fewer than a million unemployment claims. Estimates currently place the total jobless figure to be around 27 million people. This figure, of course, does not include the children and family members who are dependent on those earners. 

Beneficiaries Move from Commercial to Government Plans

Data analysts debate exactly how many people have lost their commercial insurance coverage, but the available Medicaid MCO enrollment data indicates states across the country are seeing an influx of members in government-sponsored health insurance programs. Only time will tell how much of this growth will last beyond the short term. 

According to an aggregated report by the Kaiser Family Foundation, these data are informative as more than two-thirds of beneficiaries nationally receive most or all of their care through risk-based MCOs and more than half of states that contract with MCOs enroll 75% or more of their Medicaid beneficiaries in MCOs

Executive Briefing: Building a Provider Network Strategy While Navigating COVID-19

Top States for Medicaid MCO Growth

Medicaid enrollment figures were flat or saw slight decreases from March 2019-March 2020. Since the start of the COVID-19 pandemic, the states that have reported the largest percent increases in enrollment are: 

  • Nevada (+14.3%)
  • Missouri (+10.3%)
  • Wisconsin (+8.7%)
  • Minnesota (+7.5%)
  • Georgia (+6.2%)

These increased enrollment numbers will likely stretch state budgets. With care utilization still lagging by many measures, the growth of government program enrollment presents continued financial opportunity for health plans. But current scrutiny of payers makes now an excellent time to analyze provider network management strategies and identify opportunities for increased efficiency and accountability within this line of business. 

A continuous provider eligibility solution from ProviderTrust can ensure sustainable success of government programs and fight FWA in provider networks. Want to learn how? Get in touch

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