UnitedHealth, Aetna Expand Managed Care Medicaid Coverage

Recently, 2 large health insurers announced they are planning to join California’s Medicaid program.

The insurers, UnitedHealth and Aetna, have recently been scrutinized for their actions. UnitedHealth for dropping out of a majority of Affordable Care Act marketplaces, and Aetna for their plan to acquire rival insurer Humana.

However, these companies are planning to join the Medi-Cal managed care program in San Diego and Sacramento next year, according to California Healthline. Their Medicaid program currently provides health insurance for 13.4 million low income people.

Approximately 80% of enrollees have a managed care plan. In California’s managed care plans, insurers receive a fixed payment per enrollee, rather than pay for services individually. Currently, there are 22 insurers providing these plans, and the California Department of Health Care Services said it opened the program to new insurers since the current insurers were providing these plans for some time, according to the article.

However, offering these plans is not easy, since the state only offers $6000 per enrollee. An Aetna spokesperson said in the report that its decision to join Medi-Cal’s managed care program was based on the fact that it is the largest Medicaid market.

Their plan is to eventually insure up to 150,000 enrollees in San Diego and Sacramento counties, before expanding coverage to other counties, according to the article. UnitedHealth currently insures Medicare beneficiaries, and a spokesperson said they are successful in providing Medicaid insurance in other states.

The company believes that since they know the healthcare providers and the delivery system, in addition to their experience in other states, this will create a competitive market, according to the article.

If the insurers receive state approval and show they are ready to enroll patients, the plans could be offered as early as this month.