Mississippi: Open Enrollment Mystery Solved?

For the past two weeks, along with other noteworthy Open Enrollment data numbers, I've been scratching my head over what the deal is in Mississippi:

Once again, Maine remains the worst-performer year over year, mostly due to their expansion of Medicaid. Idaho isn't listed because they're a state-based exchange and haven't reported any data yet. Mississippi, on the other hand, continues to be the top out-performer vs. last year, which is interesting because there doesn't seem to be any particular reason for it.

Unlike some states, Mississippi hasn't implemented any additional subsidies, a mandate penalty or a reinsurance program of any sort. They haven't had any new carriers join the ACA market, nor have any of them left. I don't think either of the carriers on the exchange have significantly expanded their territory or changed their offerings that much either...in fact, average premiums are essentially flat year over year.

In other words, by all rights, Mississippi should be performing almost exactly as they did last year...but enrollments are up 15.5% to date. Huh.

Well, thanks to two different tipsters, it turns out that I was dead wrong about one of the above points: Mississippi did have a new carrier join their ACA market, which I had no clue about until today:

JACKSON, Miss. (WTVA) — A second insurer will be available to some Mississippians who get health insurance under the Affordable Care Act.

Molina Healthcare of Mississippi will be an option for people in Lafayette, Lee, Marshall, Panola, Pontotoc and Union counties.

Those counties are among 19 counties in the state where Molina can be selected by those seeking health care coverage through Obamacare.

For 2019, Ambetter from Magnolia Health was the only insurer in Mississippi available through the federal health insurance marketplace.

Enrollment for 2020 goes from November 1 through December 15.

Blue Cross Blue Shield of Mississippi is also offering ACA-compliant policies, but only off-exchange.

More to the point, however, apparently Molina is undercutting Ambetter on policies in the most populated areas of the state, presumably opening up $0 or near-$0 premiums for many people thanks to Silver Loading for 2020, although Dave Anderson says he isn't seeing anything in their pricing which would indicate that.

Anyway, regardless of whether this solves the mystery, it's at least worth noting anytime a second major carrier enters a new market, so there you have it.

Here's the official press release from back in October:

MISSISSIPPIANS HAVE NEW CHOICE FOR HEALTH INSURANCE IN 2020

MOLINA HEALTHCARE OF MISSISSIPPI TO ENTER THE HEALTH INSURANCE MARKETPLACE FOR THE FIRST TIME  

JACKSON, Miss. – Commissioner of Insurance Mike Chaney announces that Molina Healthcare of Mississippi will be added as an option on the Health Insurance Marketplace (also known as Exchange) starting in 2020.

Molina Healthcare of Mississippi already serves Medicaid members through MississippiCAN and will begin covering minors through the state’s Children’s Health Insurance Program (CHIP) on November 1, 2019.

“The addition of CHIP and Marketplace plans is a good thing for families looking for insurance,” said Commissioner Chaney. “Up until now there has been only one provider in the Mississippi Marketplace. Increased competition and market share can only benefit consumers.”

Molina will be offered in 19 counties including Desoto, Forrest, Hinds, Hancock, Harrison, Jackson, Jones, Lafayette, Lamar, Lee, Madison, Marshall, Panola, Pearl River, Pontotoc, Rankin, Tate, Union and Warren. Molina’s competitively priced Marketplace plans include free preventive care including screenings, family planning and preventive drugs, as well as easy access to a wide network of doctors and hospitals. Molina Marketplace plans also include telemedicine services that provide 24/7 access to quality doctors for the same low copay as a primary care visit.

The open enrollment period for Marketplace in Mississippi begins November 1 and runs through December 15 for a membership effective date of January 1, 2020. Those interested in enrolling can visit ChooseMolina.com for more information.

About Molina Healthcare:

Molina Healthcare, Inc., a FORTUNE 500 company, provides managed healthcare services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through its locally operated health plans, Molina Healthcare served approximately 3.4 million members as of June 30, 2019. For more information about Molina Healthcare, please visit molinahealthcare.com.

UPDATE: Just got some additional information about the Mississippi exchange situation from Amy Lotven of Inside Health Policy:

Mississippi Insurance Commissioner Mike Chaney attributes the increased signups to the entry of another carrier - Molina Health - for the 2020 plan year, as well as the insurance department’s efforts to educate consumers about options. Chaney tells Inside Health Policy that the state now has 71,800 plan selections, with 68,955 of the people signing up eligible for subsidies. Ambetter currently has the most consumers, about 70,300, while Molina has the remainder, Chaney says.  

He expects another 20,000 or so people will enroll by the Dec. 15 deadline.  

Hmmm...if Ambetter has a whopping 98% of total enrollments and new-kid-in-town Molina only has 1,500, it seems to confirm that Molina jumping in didn't cause the 15% enrollment spike. Huh.

Assuming they do add another 20K, that would put Mississippi up at 91,800, which would be about 3.7% higher than last year, which seems much more reasonable.

Mississippi's total QHP selections during the 2019 OEP were 88,542 people, so that 71.8K figure pretty much has to include auto-renewals, which is interesting since HC.gov doesn't officially plug in auto-renewals until the last week of Open Enrollment, so either they've already done so but just don't report them until the final week, or there's been some sort of policy change about the timing of doing so. Last year Mississippi only had 35,400 enrollees as of 12/01, so...yeah.

Also, 96% of those 71.8K enrollees are subsidy-eligible, which is even higher than last year's 94.4%.