Dive Brief:
- Centene has been awarded a contract in New Hampshire to manage physical and behavioral health, along with pharmacy services, for the state’s Medicaid managed care population.
- Centene has provided Medicaid managed care in the state since 2013 through a subsidiary called NH Healthy Families. The new contract, which was approved by Governor Chris Sununu earlier this month, is effective from September 2024 through August 2029.
- The New Hampshire Department of Health and Human Services has yet to post the contract on its website, and Centene did not respond to a request for comment. However, the state’s previous contract allocated more than $6 billion for managed care organizations, or MCOs, over its five-year term.
Dive Insight:
Nearly all states have some form of managed care in place, and contract with risk-based MCOs like Centene to provide care for certain Medicaid populations. MCOs are paid a set per-member per-month amount for their services.
NH Healthy Families is one of three MCOs selected by the New Hampshire for the new five-year managed care contract.
Over the last decade, the payer has grown to cover almost 93,000 New Hampshire residents on Medicaid, roughly half of the 178,000 lives covered by the state’s managed care contract overall.
Centene is vying with two other insurers for Medicaid lives in the Granite State: AmeriHealth Caritas New Hampshire and Boston Medical Center Health Plan, which does business as WellSense Health Plan.
Centene is the largest Medicaid insurer in the U.S., with contracts with 31 states. The payer, which brings in the lion’s share of its revenue through business with government programs, has swelled its Medicaid business over the past few years through a number of new contracts with states, including Oklahoma and California.
Like other Medicaid payers, Centene has also benefited from Medicaid enrollment snowballing over the COVID-19 pandemic, as state regulators stopped checking members’ eligibility in exchange for more federal funding.
However, states resumed eligibility checks in April in a process called redeterminations that has chipped away at that growth. Some 15 million Americans have been disenrolled from the safety-net coverage during redeterminations, many for so-called procedural errors like incorrect paperwork instead of confirmed ineligibility.
Centene itself has lost 1.1 million Medicaid members since redeterminations began, executives said during a third-quarter earnings call in October. Centene expects to lose roughly two million members once redeterminations are complete.
However, the majority of states are retroactively increasing rates to reflect the shifting member mix, which should mitigate the worst of redeterminations’ financial hit, according to the St. Louis-based payer.
Still, Centene lowered its 2024 earnings guidance last year due to expectations that Medicaid redeterminations will increase spending and lower premium revenue. The payer also laid off 3% of its workforce in September.
