Inland Empire Health Plan is in preparation mode as the Medicaid managed care plan faces the loss of up to 350,000 members as a result of the impending impact of HR 1.
“We’ve got to do everything we can to keep members in the care that they are in with their providers,” CEO Jarrod McNaughton told Becker’s. “This is going to impact the entire industry, and a lot of different industries outside of healthcare too.”
IEHP is a publicly-operated insurer covering 1.4 million people across California’s San Bernardino and Riverside counties, predominantly through Medi-Cal. Beginning in 2027, Medicaid work rules for most of the expansion population will take effect nationwide, along with more frequent eligibility checks. The CBO has projected that 10 million more people will be uninsured by 2034 as a result of the law, mostly stemming from the Medicaid (7.5 million) and ACA (2.1 million) provisions.
IEHP’s foundation has been building a volunteer and community service program to connect members with opportunities to meet the 80-hour monthly threshold under the new work requirements. And rather than wait for the expected coverage declines to force cuts locally, IEHP stopped backfilling vacant positions two years ago. As a result, the organization’s total headcount has come down from about 4,400 to 3,600 through attrition alone.
“We’ve really held firm on not backfilling roles, just to get us ready,” Mr. McNaughton said. “That puts us in a uniquely different position than most of the other local plans here in California. Many of them are planning on doing pretty big layoffs next year.”
IEHP has also built a tool in its provider portal that flags patients with a redetermination due within 60 days. The alert prompts front office staff and physicians to raise the issue during visits and help eligible members stay enrolled. Mr. McNaughton called the data push “key to making sure that people stay on the Medicaid program if they should be on the Medicaid program.”
“I am very concerned that this is simply going to be a paperwork obstacle for people, and that they just simply will not be able to stay on the Medicaid program because our counties can’t keep up,” he added.
The insurer is also using its ACA exchange product as a safety net for members cycling off Medi-Cal, a strategy being employed by a few other insurers in the region. State law allows individuals who lose Medicaid benefits to be auto-enrolled into the lowest-cost silver plan in their area, which IEHP says it is within its region next year. Further out, the plan is considering an expansion into the Medicare Advantage market within the next few years.
“As a public entity, we can be the public option to make sure that as little as possible of dollars are leaving our communities,” Mr. McNaughton said.
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