PHE; MCOS- JPM23: Centene gears up for Medicaid redeterminations to begin

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[MM Curator Summary]: Centene is ready to help make sure revenues transition seamlessly from Medicaid rate cells to ACA rate cells on the exchange.



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SAN FRANCISCO—States now finally have a timeline for when Medicaid redeterminations, which were paused during the COVID-19 pandemic, can resume.

Centene, a major player in Medicaid managed care, is gearing up to assist in this endeavor, executives said Monday during a J.P. Morgan Healthcare Conference session. CEO Sarah London said that because the timetable for the COVID public health emergency was nebulous, many state agencies have had a year to think about their strategy around redeterminations.

Thanks to the recently passed omnibus bill, states know they now can begin redeterminations April 1 even if the public health emergency remains in effect. London said that 88% of the states Centene works with believe they’ll need at least 10 months to complete the redeterminations.

But the extra planning time has afforded states the ability to design a plan to avoid too much “member abrasion,” she said.

“One of the benefits of the fact that we were all preparing for redeterminations at this time last year is that it has allowed a year to think about the right administrative approach,” London said.

She added that the omnibus bill also enables Medicaid managed care plans to assist states more effectively in member outreach, which can also ease the landing for them if they lose Medicaid coverage.

Many in the industry have sounded the alarm about the potential for the redetermination process to boot significant numbers of people off of their health coverage. A report released last month by Urban Institute, a left-leaning think tank, estimated that 18 million people could lose Medicaid coverage because of the redeterminations.

While that figure is bleak, the individual market does offer an opportunity to catch some of the people who may be forced out of the Medicaid program. Enhanced premium subsidies for exchange plans were extended for several years, making coverage more affordable for a broader swath of people.

London said that the enhanced subsidies also offered a path to reach people who have been chronically uninsured and would likely never otherwise have signed up for an Affordable Care Act exchange plan.

“The marketplace subsidies taught the industry where to find those members,” she said.

Enrollment in exchange plans has skyrocketed to record highs over the past two years, thanks in large part to the enhanced subsidies as well as rolling special enrollment windows that have captured more people.

However, as enrollment increases, the Biden administration has looked to push insurers to offer more standardized coverage options, which can make it easier for consumers to select a plan.

London said Centene has rolled out multiple new product designs on the exchanges in the past year and that it’s clear what works for one consumer may not work for another.

“I think limiting product design for something that is hyper-standardized is not good for consumers in the long term,” she said.