Hearken to the article
Dive Transient:
Iowa has awarded Centene a brand new Medicaid managed care contract, extending the insurer’s participation within the state’s $6.7 billion Medicaid program for one more six years.
Centene subsidiary Iowa Complete Care has held a managed care contract within the state since 2019, serving beneficiaries in Iowa’s safety-net insurance coverage program with a rotating solid of different insurers.
Complete Care’s award, which the state introduced final week, standardizes Iowa’s Medicaid contract timeline. Now, Centene’s contract, together with contracts held by Elevance and Molina, are all scheduled to run out in 2031.
Dive Perception:
The contract award maintains enterprise as typical for managed care organizations, or MCOs, in Iowa Medicaid. In 2022, the Hawkeye State granted Molina and Elevance subsidiary Wellpoint Iowa contracts to supervise the care of its Medicaid beneficiaries, whereas Centene was driving out an present contract.
Now, all three contracts are on the identical schedule, whereas Iowa’s roughly 720,000 residents on Medicaid and the Kids’s Well being Insurance coverage Program ought to see no adjustments in advantages, in keeping with state regulators.
Iowa, which enacted a Medicaid managed care mannequin 5 years in the past, spent $6.7 billion on Medicaid in its final fiscal 12 months. Of that tranche, $6.2 billion went to MCOs, in keeping with the state’s Medicaid dashboard.
Centene, which at the moment covers rather less than one-third of that inhabitants, obtained virtually $2.8 billion within the 2023 fiscal 12 months. For the reason that insurer first started protecting Iowa Medicaid beneficiaries, it has obtained virtually $9.5 billion from the state.
Iowa’s state legislature voted to denationalise Medicaid in 2016 in a controversial choice, as suppliers mentioned handing this system over to for-profit entities would create obstacles to healthcare entry.
Contracting with non-public insurers is the dominant technique of Medicaid supply within the U.S., with virtually all states adopting some form of managed care mannequin. Nevertheless, issues about high quality have dogged managed care, with analysis discovering excessive charges of protection denials sparking a congressional investigation into MCOs.
After the state transitioned to the brand new mannequin, three payers held managed care contracts, however AmeriHealth Caritas withdrew in 2017 and UnitedHealthcare in 2019, citing main monetary losses within the state.
Iowa obtained 5 bids for Medicaid contracts in 2022 earlier than issuing the extra awards to Molina and Elevance.
It’s been a busy 12 months for Medicaid awards, with Mississippi, Rhode Island, Kansas, Florida, New Hampshire, Texas, Virginia and Michigan all issuing new contracts.
