Analysts Predict Robust Earnings For Medicaid Managed Care, Despite State, Federal Concerns

[flamingdem]

https://insidehealthpolicy.com/daily-news/analysts-predict-robust-earnings-medicaid-managed-care-despite-state-federal-concerns

January 04, 2017

Medicaid managed care plans profited from Medicaid expansion, but repealing those expansions might not hurt plans that are well positioned to take on the sickest and poorest beneficiaries, analysts say, as states consider moving beneficiaries who historically have been covered by fee-for-service Medicaid into capitated managed care plans to prepared for the potential of shrinking federal contributions that would likely result if Congress sets up block grants or per-enrollee funding caps. However, some states are at odds with managed care plans over which services should be covered, and lawmakers are scrutinizing the companies for fraud through anti-kickback regulations that companies say impede their integrated care systems.

Many states cover the sickest and most expensive patients with fee-for-service Medicaid, but managed care plans hope to continue picking up contracts to cover these patients. These patients make up 20 percent of the Medicaid population but account for 80 percent of Medicaid spending, which makes them an appealing bet for companies seeking to grow. Medicaid programs collectively spend about $200 billion on this population, according to a September report from Bank of America and Merrill Lynch.

“Even if you take Medicaid expansion away, we expect this market to keep growing,” said Joe Marinucci, senior director with Standard & Poor’s Ratings Services. “Those populations are coming in, and they are high value.”

Jeff Myers, president of Medicaid Health Plans of America, said he expects all of these beneficiaries to move into managed care in short order.

“The last couple of years has been driven not just by increase of population because expansion, but because states are moving more of the population into managed care,” Myers said.

The Merrill Lynch and Bank of America report said the GOP push for block grants or per-capita caps for Medicaid make the financial forecast brighter for managed care plans.

“We view block-grants as a potential catalyst for increased adoption of Medicaid Managed Care for programs that are still being run in fee-for-service settings,” the report states. “The rationale is that if states have to cover the same number of people, but with fewer federal dollars, they will increasingly look to MCOs who have shown the ability to save 15%+ vs. unmanaged spending, while also improving quality.”

However, S&P's Marinucci said Medicaid managed care companies still face risk. “We’ve seen the counterpart of that on the Medicare side,” he said. “You have the base population of Medicare enrollees, and then the sub groups with higher acuity. If you are going to deal with those groups, you have to have confidence.”

[Wellstone ruled]

1. Was a member of our

Teamsters Health and Welfare board years back. When we selected a Health Care Insurer for our Members,we brought in the Insurance Brokers and their Nuts and Bolts Gurus. Main thing we learned is this. The Insurance Bean Counters look at the whole group,and their smart people will tell you this,it takes 18 months to clean up your group of Medical Needs and after that we the Insurers make money. There again,I am talking about a group that has never had health care coverage. Yes we saw some pretty crappy coverage options,and our group always had zero copays with first dollar coverage. And those plans are still in place today.

Amazing how no one talks about the front end loading of Insurance costs and what they are all about.

[flamingdem]

2. Great point, and it happened to me when I got out from under my 6500 deductible with Anthem

Now I have a very low deductible and have dealt with many issues I was just ignoring previously.

And next year plan to use it very little, so you are right and this is another detail that is hard to explain in sound bites.

[Wellstone ruled]

3. But,we have to deal with all the false Propaganda

coming from the Anti ACA Smuck's. This whole repeal is a Tax break of Business and the 1%ers.

Got to love the phase Universal health insurance,meaning,you buy your own Insurance out of pocket at what ever the Market rate is. And if you have a pre-condition,tough shit just go over there and die.

[flamingdem]

4. Ryan thinking and almost saying "It's not my fault

you have a pre-condition, that's the breaks"

[Wellstone ruled]

5. That seems to be the Rethug response to

everybody and anybody. Frank Luntz must have focus groped it for the Rethugs