Over 90% of Medicaid is now privately administered?

November 29th, 2022, via the Centers for Medicare & Medicaid Services:

Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.

As of August 2022, 64,942,984 people are enrolled in Medicare. This is an increase of 111,278 since the last report.

  • 34,939,872 are enrolled in Original Medicare.
  • 30,003,112 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage. 
  • ...As of August 2022, 90,550,412 people are enrolled in Medicaid and CHIP. This is an increase of 587,411 since the last report.
  • 83,494,001 are enrolled in Medicaid
  • 7,056,411 are enrolled in CHIP

As I noted at the time:

46.2% of all Medicare enrollees are now enrolled in Medicare Advantage, the privately-administered version of the program. This trend has been growing every year for the past couple decades, for good or for bad.

December 6th, 2022, via Mark Farrah Associates:

As the federal government continues to extend the Public Health Emergency, managed care companies that participate in Managed Medicaid markets are seeing windfalls of enrollment due to the unprecedented growth in the segment. These carriers provide coverage for 75.6 million people, as of September 2022, up from 70.2 million in September 2021. In this Business Strategy Report, utilizing information from its Health Coverage Portal™, Mark Farrah Associates (MFA) examines how carriers in the Managed Medicaid segment have fared between the third quarter of 2021 (3Q21) to the third quarter of 2022 (3Q22).

Molina reported the largest percentage increase in membership between 3Q21 and 3Q22, at 15.1%, with a gain of nearly 582,000 managed Medicaid members. Anthem, meanwhile, was one of few top companies to see an increase in market share (+0.7%) and experienced the largest membership increase, over 1.1 million enrollees, representing a 13.4% increase year-over-year. The table below shows that the top 10 companies, in September of 2022, all increased in Medicaid enrollment from the same period in 2021.

I admit to not being certain about this; Kaiser Family Foundation data suggests that MCO enrollment made up around 72% of total Medicaid enrollment as of 2020, up from 69% in 2018. While the MCO trend has been increasing for a long time, jumping by another 18 points in just 2 years seems like a bit of a stretch; it's possible that Mark Farrah's data includes some other types of enrollment which are measured differently than "official" Medicaid programs.

Then again, the Medicaid Continuous Enrollment rules during the COVID pandemic, combined with the expansion of Medicaid in Missouri and Oklahoma in 2021 may have triggered an even faster jump in MCO enrollment.

Whether you're a fan of privately administered publicly funded healthcare coverage or not, it is what it is.