The Bottom Line

State re-verification efforts impact risk mix

PBM spread-pricing dominates the news

Multiple new CMS regs and guidance letters

Executive Summary

Highlights from this issue:

  • The 2nd quarter of 2019 closed with a cautious outlook from most plans in terms of MLR and growth.
  • CMS is pushing states to enforce program integrity rules around eligibility.
  • Duals plans now have extensive new guidance around integration of BH and LTSS services.
  • New disruption in the PBM space occurred with the proposed rules around safe harbor limits.  
  • PBM spread pricing issues dominated news cycles in key markets (Ohio and Kentucky)
  • Quarter to quarter revenues were flat for most MCOs, but significant increases for Cigna and CVS-Aetna. Stock interest fluctuated during progression of WellCare/Centene deal.

Latest MCO leader survey results coming in Q3 Issue
(survey is run every 6 months)

Industry Interviews

Each issue we interview a Medicaid Managed Care executive and an Investment Leader

Erhardt Preiteauer

CEO, CareSource

Binoy Bhansali


MCO Financial Performance


Most MCOs closed out Q2 with fairly flat revenues and EBITA. Market showed variable interest in Q2 based on pricing and volume behaviors (mostly tied to progression of WellCare/Centene deal)

  • First analysis with Aetna data and trends absorbed into CVS reporting. 

Latest MCO Quarterly Financials


Gross Profit

Earnings Before Interest and Taxes

Detailed Analysis













CVS (Aetna)





















A Quick Glance At Key Regulations With Possible Impact to Medicaid Plans
  • Public charge rule moved to OMB (July)
  • New CMS guidance to states on Medicaid eligibility
  • CMS to overhaul nursing home review rules
  • PACE regs updated
  • New CMS rules on duals plans
  • Comment period for Interoperability rule closes
  • Home health workers union dues rule changes triggers multi-state lawsuit
  • Changes to wage index for rural hospitals
  • Final telehealth rule issued (Medicare Advantage)
  • CMS weighs in on PBM spread pricing

Mergers, Acquisitions and Investment Activity 

  • Centene-Wellcare
  • United-Davita
  • CVS-Aetna
  • Magellan sale
  • Multiple provider deals
  • Multiple tech deals

Vendor Reviews

Your staff are constantly asked to sit through vendor demos and pitch meetings. Is it worth the time? 

Our simple grid below helps you decide. 

Vendor Name

Overall Assessment for Medicaid Readiness

Detailed Analysis

360 Health Systems


American Specialty Health

Automated Health Systems

CA Technologies

Collective Medical Technologies


Independent Living Systems



Need to update info in one of our reviews? Disagree with our assessment? Send us a note to clay@mostlymedicaid.com to schedule a call with one our analysts to provide more information. 

Evaluation methodology