With Medicaid Cliff Looming, Payers Scramble to Limit Outflow

The end of the COVID-19 public health emergency (PHE) is likely to significantly downsize Medicaid enrollment around the nation, and managed care organizations (MCOs) must figure out how to keep enrollment steady and maintain continuity of coverage among members.

Since February 2020, fueled by a COVID-induced economic downturn and resulting federal policy changes, the Medicaid ranks have ballooned by 14.6 million members, a roughly 21% increase, nearing 86 million enrollees, according to the Kaiser Family Foundation (KFF).

As a condition of receiving enhanced federal funds during the PHE, states have been required to ensure continuous Medicaid and CHIP coverage for most enrollees by pausing eligibility redeterminations. A quartet of large for-profit plans that hold 40% Medicaid market penetration nationally — Anthem, Inc., Centene Corp., Molina Healthcare, Inc., and UnitedHealth Group — are all expecting “modest enrollment declines” once the PHE ends, according to a recent KFF issue brief.