Best’s Special Report: Eligibility Redeterminations Put Pressure on Medicaid Managed Care Segment

OLDWICK, N.J.--(BUSINESS WIRE)--Eligibility redeterminations in the Medicaid managed care segment following the end of the public health emergency period is leading to a mismatch between acuity and rates, according to a new AM Best report.

During the public health emergency from COVID-19, the segment experienced significant enrollment growth in 2020-2022 due to the lack of Medicaid eligibility redeterminations. The Best’s Special Report, “Medicaid Redeterminations Put Pressure on Segment,” states that since the provision expired on March 31, 2023, and states resumed the process of eligibility redeterminations, Managed Medicaid insurers have seen steep declines in enrollment, with Idaho leading the way with a 38% enrollment drop and 15 other states experiencing a drop of more than 20%. Lagging rate increases have created a mismatch between acuity and pricing.

“The majority of disenrolled Medicaid members tended to be healthier members, resulting in higher acuity in the segment,” said Kaitlin Piasecki, industry research analyst, AM Best. “Current pricing still reflects the healthier risk pool, and so necessary rate increases have lagged the acuity level and led to margin pressure in the segment.”

Because of the disconnect between pricing and risk profiles, according to the report, the ratio of incurred claims to direct premium has risen by more than seven percentage points through third-quarter 2024 to 92.0 from the 2020 pandemic low point of 84.8. Managed Medicaid is a high-volume business with narrow margins, and although industry earnings have been consistently positive, margins have been tightening. The report notes that nearly all managed Medicaid filing entities are single-state writers. At year-end 2023, 70% of companies reported a decline in underwriting profitability in their managed Medicaid business.

“Profitability may be difficult for some carriers, but many of the well-known health insurers have been challenged before and have demonstrated their ability to withstand difficult operating conditions,” said Jason Hopper, associate director, Industry Research and Analytics, AM Best.

The segment recorded a $1.8 billion underwriting gain through third-quarter 2024, compared with $5.3 billion for all of 2023. Despite the rate adequacy concerns, managed Medicaid profitability is expected to improve in 2025 and into 2026, as rate increases better reflecting the recent acuity profile and trends for the currently enrolled population are implemented. However, uncertainties related to federal funding cuts to the program remain.

To access the full copy of this special report, please visit http://www3.ambest.com/bestweek/purchase.asp?record_code=352423.

AM Best is a global credit rating agency, news publisher and data analytics provider specializing in the insurance industry. Headquartered in the United States, the company does business in over 100 countries with regional offices in London, Amsterdam, Dubai, Hong Kong, Singapore and Mexico City. For more information, visit www.ambest.com.

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