Anthem continues Medicaid push as redeterminations loom

Anthem can pay an undisclosed sum to purchase Medicaid managed-care insurer Integra Managed Care from residence well being firm Private Contact Holding, the insurer introduced Wednesday.

Integra Managed Care focuses on protection of adults with long-term disabilities and presents care administration, in-home nursing, remedy and residential well being aide providers to 40,000 New York Medicaid enrollees who reside at residence. The deal is predicted to shut through the second half of subsequent 12 months, pending regulatory evaluation.

Anthem has been expanding its Medicaid footprint. This explicit deal provides the insurer a toehold in residence well being and social determinants of well being providers, which might assist the corporate enhance affected person outcomes and reduce medical spending.

“The acquisition aligns with our objective of rising Anthem’s Medicaid enterprise, whereas serving our members with a complete and coordinated strategy to care,” Felicia Norwood, govt vice chairman of Anthem’s authorities enterprise division, stated in a information launch. “Like Anthem, Integra has established connections with neighborhood teams to realize a deeper understanding of learn how to greatest assist the entire well being wants of the folks we’re privileged to serve.”

The Integra Managed Care deal comes as Anthem’s government-sponsored enterprise is increasing. In the course of the third quarter ended Sept. 30, Anthem’s income grew 16% to $35.5 billion, pushed primarily by development in its Medicaid and Medicare operations.

Anthem’s Medicaid enrollees elevated 21.1% to 10.3 million because the similar interval final 12 months. The insurer is among the largest Medicaid carriers and its enrollment is second solely to Centene’s 14.7 million.

Anthem’s Medicaid development got here from new members gained via state partnerships, acquisitions and a regulatory pause on eligibility redeterminations.

North Carolina opened its Medicaid program to managed care corporations for the first time this 12 months, and Anthem captured 426,000 new members by becoming a member of that market. Anthem additionally gained a bid to take part in Ohio’s Medicaid program, which covers 2.9 million folks. And the corporate paid an undisclosed sum to purchase MMM Holdings—the biggest Medicare Benefit and second-largest Medicaid plan in Puerto Rico—this 12 months, which added 572,000 policyholders to the corporate’s rolls.

Though Anthem’s Medicaid enterprise is increasing, the insurer expects the growth to finally bust as soon as states begin reevaluating Medicaid enrollees’ eligibility on the finish of the 12 months.

Virtually 90%, or 15 million, of the individuals who gained Medicaid protection through the COVID-19 pandemic might lose advantages as soon as the general public well being emergency ends as a result of their incomes modified through the interval when states paused eligibility evaluations, in keeping with a report from the Urban Institute.

By the second quarter of 2022, Anthem anticipates its Medicaid inhabitants to say no 65%, with about 45% of individuals returning to employer-sponsored protection and 20% turning into eligible for sponsored non-public protection from the medical insurance exchanges. As these Medicaid members search new sources of protection, Anthem goals to transform them to different, extra worthwhile merchandise.

“We might be able to flip that headwind right into a tailwind relying on the place these people go,” Chief Monetary Officer John Gallina instructed analysts through the firm’s third-quarter earnings name final month. “We do imagine that after redetermination begins that we can preserve a big quantity of that membership inside an Anthem product.”

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