The Medicaid landscape is radically shifting, and some managed care organizations have questioned whether it is sustainable to continue in certain markets.
When redeterminations restarted in April 2023 after the pandemic, average acuity increased, according to a February white paper from Wakely, a healthcare actuarial consulting firm. State rate-setting struggled to keep pace.
Challenges could continue to mount in 2027 as HR 1 continues to shape Medicaid eligibility and funding. The expansion population will face redeterminations every six months under the law, rather than annually.
Elevance Health and Molina Healthcare flagged that 2026 could be a trough year for Medicaid margins. Now, some insurers are exiting.
Here are four insurers leaving states’ Medicaid managed care programs:
- Centene’s ‘Ohana Health Plan is leaving Hawaii’s Medicaid managed care program, QUEST, on Dec. 31. Ambetter, also under Centene, will exit Arkansas’ Medicaid expansion program, Arkansas Health and Opportunity for Me, on Dec. 31 as well.
- Healthy Blue, a collaboration between Blue Cross and Blue Shield of Louisiana and Elevance Health, is leaving the state’s Medicaid managed care program Dec. 31.
- Elevance Health Medicaid subsidiary Wellpoint DC exited the District of Columbia’s managed care program Aug. 1. The insurer is laying off 85 employees in Washington, D.C., amid the transition. During a July earnings call, Elevance executives signaled more Medicaid exits in the coming months.
- Baylor Scott & White Health Plan exited the Texas Medicaid managed care market in August. The health plan cut 321 jobs as it also prepared to exit the individual marketplace ahead of 2027, according to the Dallas Morning News.
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