The “Big Five” Medicaid managed care companies—Centene, CVS Health (Aetna), Elevance Health (formerly Anthem), Molina Healthcare, and UnitedHealth Group—have reported their Medicaid enrollment for the quarter ending September 30. The downward trend that began in Q2 continued for all of the companies except Molina, which experienced a small net increase (+16,000). Centene reported the largest […]
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Our nation is in the midst of an ongoing maternal health crisis, one that particularly affects Black women. The causes are complex, the need to address them is urgent, and there is no single solution. One of many potential solutions that has not received enough attention is Medicaid managed care. Medicaid, the nation’s largest health […]
Just over 25 years ago, Congress enacted a major change in federal policy on Medicaid managed care. It eliminated the 75/25 rule—the requirement that no more than 75 percent of the enrollees in a Medicaid managed care organization (MCO) could be Medicaid or Medicare beneficiaries. The logic of the rule was that if an MCO […]
The Medicaid enrollment results for the “Big Five” during the quarter ending June 30 are now in. The Big Five have the largest share of the Medicaid managed care market: Centene, CVSHealth (Aetna), Elevance Health (formerly Anthem), Molina Healthcare, and UnitedHealth Group. They, along with two large nonprofit companies, were the focus of a recent […]
Kudos to the OIG! That would be the Office of the Inspector General of the Department of Health and Human Services. Although OIG is better known for its fraud-fighting persona, it also has a broader mission of making government programs work better. And with last month’s report, “High Rates of Prior Authorization Denials by Some […]
