HelpThe AIS Data Team has posted new data to the subscriber dashboard Online Search Tool and In-App Download Enrollment Data Spreadsheets. This data primarily reflects fourth-quarter 2020 status but includes some first-quarter 2021 data for Medicare Advantage, dual-eligibles and Medicaid membership.
Most related in-app downloads and special reports now reflect the most recent data available. Keep an eye out later this month for a detailed analysis of changes from the third quarter.
For this update, we added the following new MCOs:
• Central Valley PACE (#2005), a PACE plan operating in California;
• Texas Independence Health Plan (#2006), a Medicare plan operating in Texas;
• Astiva Health (#2007), a Medicare plan operating in California;
• Clever Care Health Plan (#2009), a Medicare plan operating in California;
• CommuniCare Health (#2010), a Medicare plan operating in Indiana, Maryland and Ohio;
• Perennial Advantage (#2014), a Medicare plan operating in Ohio;
• American Health Advantage of Missouri (#2016), a Medicare plan operating in Mississippi; and
• American Health Advantage of Texas (#2017), a Medicare plan operating in Texas.
We discontinued the following MCOs:
• Comprehensive Medical and Dental Program (#645), which was discontinued after ownership transferred to Mercy Care (#23);
• Kalos Health (#1139), which no longer offers primary medical coverage, but does offer a managed long-term care plan in New York;
• Sidney Hillman Health Centre (#1185), which left the Medicare market for 2021;
• District of Columbia (#1620), whose Medicaid membership is all managed care now;
• Wyoming PACE (#1723), which ceased operations in late 2020 due to budget constraints;
• New Mexico Health Connections (#1741), which went out of business as of January 2021;
• University of Maryland Health Partners, fka Riverside Health, Inc. (#1797), whose acquisition by CareFirst (#368) was finalized in 2021;
• Crystal Run Health Plans (#1844), which ceased operations as of 4th Quarter 2020;
• Mutual of Omaha Insurance Company (#1891), after Essence, Inc. (#1101) acquired this company's Medicare Advantage business in 2020;
• GHS Senior Care (#1903), which merged under Prisma Health brand with Palmetto Senior Care (#1031);
• Sunrise Advantage Plan (#1929), which left the Medicare market in January 2021;
• Lighthouse Health Plan (#1957), which was acquired by Anthem's (#1264) Simply Healthcare subsidiary in February 2021; and
• Clarion Health (#1983), which ceased operations in 2021.
We renamed three new MCOs in this update:
• Aspirus Health Plan (fka Aspirus Arise Health Plan), #1976, to reflect the company’s change in branding;
• Prisma Health (fka Palmetto SeniorCare), #1031, to reflect the company’s consolidation; and
• Universal Care (dba Brand New Day), #1380, to include the company’s recognizable names in the market.
We made two major parent changes to reflect acquisitions that closed since our last update, including:
• Florida MHS, Inc. dba Magellan Complete Care (#1795) is now reflected under the Molina Healthcare parent (Owner ID #28), after the acquisition closed in early 2021. We will continue to run the records separately until Magellan’s membership and business operations are fully consolidated under Molina.
• BlueCross BlueShield of Western New York and BlueShield of Northeastern New York (#277) is now reflected under the Highmark Health parent (Owner ID #6), after the acquisition closed in March 2021. We will continue to run the records separately until business operations are fully consolidated under Highmark.
In addition, while we are aware that Tufts Health Plan (#172) and Harvard Pilgrim Health Care (#171) finalized their deal to combine operations, since they have not yet announced a new name and will continue to operate separately for now, we will continue to list them separately.
Medicaid continues to steadily climb, increasing from last quarter by nearly 3M members as states are better able to report new enrollments. Most significant jumps come from states that experience a greater lag time in their ability to report new enrollments, but we are continuing to see increases across the board in managed Medicaid. State Medicaid is still waning in some states, but this usually corresponds to an increased on the Medicaid HMO side.
Notable shifts in the Medicaid space include:
• District of Columbia (#1620): The District of Columbia state Medicaid record will be ended for the April update. Around 19,000 Medicaid adult beneficiaries transitioned from FFS, and MCOs received a nearly equal number of enrollees through the reassignment process (auto assignment to a new MCO). Also of note in D.C.: MedStar Family Choice (#668) replaces Anthem’s Amerigroup subsidiary as a contracted Medicaid MCO.
• Kentucky, where managed Medicaid plans jumped 211K, an increase of 16% over the previous quarter. This coincides with an 122K decrease on the fee-for-service Medicaid side, part of an overall trend of states moving FFS members to managed care plans. New entrant UnitedHealthcare (#1263) gained 138,356 Medicaid members in Kentucky.
• Nebraska saw its managed Medicaid membership jump by roughly 25K, while its FFS membership also increased (more than 13K). Meanwhile, Anthem took over WellCare’s contract in the state.
Commercial risk is still decreasing somewhat, dropping 725K lives since last quarter. Publicly traded insurers are continuing to report decreases on the administrative services only/self-funded side, but this is also leveling off. Other notable enrollment shifts since last quarter include an additional 1.4M members enrolled in Medicare Advantage and nearly 250K dual-eligibles for the 2021 plan year.
Need more help? Contact support@aishealth.com with questions about how to use or interpret the information provided to you in AIS’s Directory of Health Plans. A member of AIS Health’s support staff would be happy to provide a free demonstration of the website for clients needing more guidance on how to best use this tool.