Medicaid Plans’ Administrative Expenses Decelerated in 2024, Webinar

PHILADELPHIA--(BUSINESS WIRE)--In 2024, core per member administrative expenses in Medicaid-focused plans grew by 5.0%, slower than the 5.3% growth in 2023. Total expenses increased by 3.6% versus 5.4% in 2023. Both trends hold constant universes and product mixes. Median Core costs were $44.49 PMPM (per member per month) for all surveyed health plans and their products. Median Core costs for Medicaid were $36.08 PMPM.

The results are summarized in Plan Management Navigator posted at sherlockco.com/navigator. Navigator includes excerpts from the 2025 Medicaid plan edition of the Sherlock Benchmarks. The fourteen surveyed plans served 9.4 million Medicaid members. In addition, the reports include 1.5 million members from other Sherlock Benchmarks universes. In all, Sherlock-surveyed plans include at least 14% of all Medicaid members and 28% when publicly traded companies are excluded.

The Sherlock Benchmarks assist health plans in managing their administrative costs. This is a central priority because of the recommencement of Medicaid redeterminations, rising health benefit ratios and ongoing debates over Medicaid and ACA funding in the 2025 Continuing Resolution discussions.

We will discuss the results in a free web conference on Wednesday, October 22^nd, from 2:00 PM to 3:00 PM Eastern Daylight Time. Douglas Sherlock will offer a brief presentation, followed by questions and answers. To participate in the web conference, register at sherlockco.com/webinar. Once registered, dial-in information and a link to connect will be provided in a confirmation email.

The Sherlock Benchmarks are the health plan industry’s “gold standard” metrics of administrative activities, costs and operational drivers. They reflect 28 consecutive years and more than 1,000 health plan years of experience. Health plans use the Sherlock Benchmarks to determine whether their administrative costs are optimal and to prioritize improvements among numerous activities. Other applications include informing strategic corporate planning and cost-benefit analyses.

This year, Benchmark participants serve 59 million Americans in Medicaid, Blue Cross Blue Shield, Independent/Provider-Sponsored and Medicare plans. Health plan users of the Sherlock Benchmarks serve over 170 million members since June 2022.

Sherlock Company (www.sherlockco.com), based in Gwynedd Valley, Pennsylvania, provides informed solutions for health plan financial management. Since its founding in 1987, Sherlock Company has been known for its impartiality and technical competence in service to its clients.