Enrollment in Medicaid HMOs drops 13.5% in first quarter, will Likely Reduce 2024 Revenues by More Than $1 Billion
Enrollment in Medicaid managed care, the largest and most profitable line of business for Minnesota HMOs, has dropped sharply, affecting their premium revenues and profitability and likely reducing revenues to hospitals and clinics. After setting records in 2022, net income for Minnesota HMOs dropped by 77.5% in 2023.
The new report finds that:
- In the past 10 years, Minnesota HMOs and County-Based Purchasing plans have earned $1.579 billion in underwriting income on Medicaid managed care and other public programs. Those enrolees now account for 72% of the membership of the HMOs and County-Based Purchasing (CBP) plans.
- In the first quarter of 2024, enrollment in Medicaid HMOs dropped by about 156,000 or 13.6%. Enrollment decreased by almost 61,000 at UCare and by 52,000 at Blue Plus. Beginning in July 2023, Minnesota began the process of reverifying eligibility for Medicaid. As of June 2024, more than 354,000 have been dis-enrolled from the program, most of them in managed care plans, and many of them dropped for “administrative reasons.” On an annual basis, those enrolees losing benefits in the first quarter would account for more than $1 billion in revenues to the health plans.
- After posting record profits in 2022, driven by strong results for the public programs, net income for Minnesota HMOs dropped by 77.5% in 2023. Minnesota HMOs had net income of $148.9 million in 2023, or 0.9% of their premium revenues. That was down from net income of $635.8 million in 2022, or 4.3% of revenues. Underwriting income from the public programs dropped from $726.5 million in 2022 to $393.9 million in 2022. UCare, the largest HMO in the state, saw its underwriting income on public programs drop from $276.4 million in 2022 to only $8.5 million in 2023. HealthPartners had underwriting income of $186.9 million on its public programs but lost $167 million on its commercial and Medicare plans. Blue Cross Blue Shield was profitable on its employer group plans but lost $103.4 million on its Medicare Advantage plans.
Please Note: Price Includes a subscription to parts one and two of the report.
Table of Contents
Introduction
Market Structure
- Health Plan Companies
- Network Arrangements and Provider Systems
Trend Review
- Health Plan Enrollment
- Individual Markets and MNsure
- State Healthcare Programs
- Medicare Health Plans
- Health Plan Net Income.
- Financial Results by Line of Business
- Administrative Expenses
- Health Plan Capital
A Look Ahead
Methodology
The reports analyzing state health care markets are intended to be a resource to health care organizations facing a full range of challenges but also seeking to identify and benefit from opportunities that present themselves.
This report is presented in three main sections. The first part, Market Structure, describes the major health insurers and hospital systems in the state, showing recent entrants and the high-level of consolidation that has occurred in both the health plan and provider markets. Market Trends, the next section, presents our analysis of enrollment trends and financial results for the health insurers. The last section contains our analysis of financial and inpatient utilization data on the hospitals in the state.
The analysis of health plan companies is based on their annual and quarterly statements filed with the Department of Insurance, including forms prescribed by the National Association of Insurance Commissioners and supplemental reports required by the state. The publisher also uses Medicaid data from the Department of State Health Services and Medicare health plan and hospital data from the Centers for Medicare and Medicaid Services. The publisher has that data together with insights that they have gained in interviews with dozens of leaders in health care organizations in the state.
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