Health Plans Prepare for Pent-Up Demand Under Medicaid Expansion

Community Medicaid health plan provider networks often overlap, and the increase in enrollees across Medicaid plans may collectively place greater-than-expected demands on participating providers.

The Issue

In the seven communities studied—Baltimore; Portland, Ore.; Denver; Long Island, N.Y.; Minneapolis/St. Paul; Richmond, Va.; and Albuquerque, N.M.— health plans are juggling enrollment growth while also adapting to major changes in state Medicaid managed care programs aimed at improving care delivery and containing costs.

Key Findings

  • All of the communities—except Richmond—are in states that opted to expand Medicaid under the ACA and that had relatively high-income limits for Medicaid eligibility before the ACA.

  • To prepare for the overload, Medicaid health plans were largely ramping up existing strategies—while also trying a few targeted new ones—to manage care.

Conclusion

In the seven communities, Medicaid health plans appeared largely prepared to manage significant Medicaid enrollment growth under the ACA. The plans with the greatest confidence going into reform were those with some knowledge of the new population.
 

About the Grantee

Mathematica Policy Research is dedicated to improving public well-being by bringing the highest standards of quality, objectivity, and excellence to bear on information collection and analysis for our partners and clients. The company has been at the forefront of assessing the effectiveness of policies and programs since 1968.