States Grapple With Payer Protests, Duals Transitions in Latest Round of RFPs
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Dec 19, 2024
Amid a shaky year for the public sector, managed Medicaid contract wins are crucial for payers looking to secure revenue streams. The managed Medicaid population has shrunk to 65.7 million beneficiaries following months of post-COVID eligibility redeterminations, down from more than 75 million before disenrollment began, according to AIS’s Directory of Health Plans (DHP). This could be one reason why the latest requests for proposals (RFPs) have been ultracompetitive, sparking contentious legal challenges from payers that are not selected.
Georgia is the latest state to unveil a round of contract awards, selecting four MCOs that will begin service in 2026 if finalized. The awards represent a significant shake-up for the state, and include just one incumbent, CareSource. Elevance Health, Inc.’s Amerigroup Georgia and Centene Corp.’s Peach State Health Plan currently serve 75% of Georgia’s managed Medicaid population combined, according to DHP. Slated to join the program in their place are Molina Healthcare, Inc., Humana Inc. and UnitedHealthcare. Whether Elevance or Centene plan to contest the awards remains to be seen — the state continued to extend the deadline to file protests as of AIS Health press time.
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