MM Curator summary
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[MM Curator Summary]: Winners: Molina, Centene, UHC. Losers: Community care of NE (HealthyBlue) and Medica Community Health Plan.
- Nebraska has selected three insurers to provide healthcare coverage to the roughly 360,000 beneficiaries in the state’s Medicaid managed care program, called Heritage Health. The three health plans are Molina Healthcare of Nebraska, Centene subsidiary Nebraska Total Care, and UnitedHealthcare of the Midlands, the state announced.
- The new contracts are for five years, with the option to renew for two additional years, Nebraska’s Department of Health and Human Services said. The state’s Medicaid managed care program offers access to physical health, behavioral health, pharmacy, hospital, dental and other services.
- The state received five bids for the contracts from health plans in July, following a request for proposals in April. Not selected were Community Care Plan of Nebraska, known as Healthy Blue, and Medica Community Health Plan.
Enrollment in Medicaid swelled during the COVID-19 pandemic, supported by state program expansions and federal relief legislation that suspended enrollee coverage terminations during the public health emergency. Managed care organizations cover more than two-thirds of all Medicaid beneficiaries.
Nebraska voters approved Medicaid expansion in a 2018 ballot initiative, and the state implemented the program on Oct. 1, 2020. The CMS agreed to the state’s two-tiered plan that offers “basic” coverage for qualified recipients and a “prime” package with enhanced benefits for enrollees who complete a work requirement. Prime benefits include vision, dental and over-the-counter drug coverage.
Nebraska said it incorporated input from stakeholder listening sessions held earlier this year into the selection process, and considered factors such as whether the plans use case management, standardize provider credentialing to ease administrative burdens, and improve access to providers across the state.
Of the three payers chosen for the state’s new Medicaid managed care contracts, Nebraska Total Care and UnitedHealthcare already have contracts with the state, and Molina Healthcare is new. The new contracts begin on Jan. 1, 2024.
Millions of Americans stand to lose Medicaid coverage once eligibility redeterminations resume after the public health emergency ends. The CMS is encouraging managed care organizations to help states prevent people from losing their coverage and has issued guidance for working through the renewal process, in hopes that insurers will be able to shift people to subsidized plans through the Affordable Care Act exchanges.