The most profitable company in the Medicaid redefining process is Maximus, the largest Medicaid eligibility and enrollment management company with a 60% market share. After Biden signed a bill authorizing “continuous insurance” claims from the 2020 law ending March 31, Maximus increased its annual revenue guidance by $100 million to $5 billion. . The company, which also operates federal Medicare and health insurance exchange call centers, did not respond to requests for interviews.
With the Medicaid redefining beginning, demand from state Medicaid departments is growing, Maximus CEO Bruce Caswell said during the company’s first-quarter earnings call in February.
“There is about 39% of the Medicaid population that is not currently in states that use providers to assist with eligibility and therefore redefinement,” Caswell said. “These are customers with whom, if they have a problem, we can develop a relationship with them. [We can] add, if you will, new state customers through this process, unlike what we did during the pandemic.”
Caswell said most of Maximus’ new contract work will begin in the third quarter and last a year. Many of the company’s agreements with states include performance pay provisions, he said, which gives Maximus the financial incentive to find as many people who are not eligible for Medicaid as possible.
Logistics
According to the Department of Health and Human Services, up to 8 million people could lose Medicaid for procedural reasons, such as not having current contact information on file even though they are financially eligible. The health insurance companies that administer Medicaid benefits, the states, the federal government, and patient advocates are multi-faceted efforts to reduce that risk.
Federal law limits the services contractors such as Maximus, Public Consulting Group, and Automated Health Systems can provide. For example, public officials must make the final determination of eligibility. But state employees can base those calls on data provided by contractors and other organizations. Furthermore, if states rely on an automated eligibility system, bidders can input those data into the algorithms used to determine eligibility.
States have 14 months to complete the redetermination process, although additional federal funding for Medicaid will end later this year. The accelerated timelines put additional pressure on some parts of Medicaid to enter into outside contracts.
After the Arkansas Legislature ruled that its Department of Health Services must complete its Medicaid eligibility review in six months, the agency skipped the competitive bidding process and doubled down on the contract. his current Maximus coin to $58 million.
Gavin Lesnick, a department spokesman, said in an email: “We needed to act quickly, and we used a partnership agreement to lock in a competitive solicitation rate run by another state. . “We are confident that we have developed a disbursement plan that meets requirements at both the state and federal levels, protects taxpayer dollars, and that will protect reasonable interests for taxpayers.” eligible for Medicaid.”
Mr. Lesnick added that Arkansas is relying on Maximus to process Medicaid applications, perform customer service and support agency staff.
According to Modern Healthcare’s analysis, more than 230,000 Arkansas people will be removed from Medicaid.
