States that have chosen to expand Medicaid programs as permitted by the Patient Protection and Affordable Care Act will represent the greatest opportunities for increased health insurance sales during the next two years, according to an Avalere Health study.
Avalere used its model for Medicaid managed care enrollment to create projections on a state-by-state basis for new covered individuals enrolling in Medicaid and Children’s Health Insurance Program. For 2015, Avalere’s projections suggest that 79 percent of those eligible for coverage in expanded Medicaid states will be enrolled, versus 74 percent in the United States overall. The gap between expanded states and those that chose not to expand is higher, Avalere said.
“The vast majority of people who have insurance as a result of the Affordable Care Act are enrolled in private plans,” said Dan Mendelson, CEO of Avalere Health. “This is a major business opportunity for plans, and often also helps to promote continuity of care as low income people migrate between Medicaid and subsidized exchange coverage.”
Avalere projects that 13.5 million new individuals will enroll in Medicaid and CHIP managed care plans from 2013 to 2016, and said that managed care enrollment will increase from 67 percent of total Medicaid and CHIP enrollees in 2013 to 76 percent in 2016.
Avalere noted that the Centers for Medicare & Medicaid Services reported an additional 8.7 million people have enrolled in Medicaid as a result of the PPACA.
“The growth is attributable to states’ decisions to expand the program, as well as the indirect effects of people learning about and enrolling in programs for which they were previously eligible (sometimes called ‘the woodwork effect’),” Avalere said in a release.
“Medicaid managed care offers states the opportunity to deliver coordinated care to Medicaid beneficiaries at a defined cost,” said Caroline Pearson, vice president at Avalere Health. “As a result, the projected growth in Medicaid managed care enrollment is driven by not only expansions under the ACA, but also state decisions to expand managed care programs to all or most of their existing beneficiaries.”
Avalere said enrollment in Medicaid managed care “is particularly high in states that decided to expand Medicaid — both because these states relied on managed care more heavily before ACA expansion and because newly eligible beneficiaries are largely enrolling in managed care plans. … Of the 28 states and the District of Columbia committed to expansion, 16 states and D.C. plan to enroll over 90 percent.