Anthem continues Medicaid push as redeterminations loom

Anthem continues Medicaid push as redeterminations loom


Anthem will pay an undisclosed sum to buy Medicaid managed-care insurer Integra Managed Care from home health company Personal Touch Holding, the insurer announced Wednesday.

Integra Managed Care specializes in coverage of adults with long-term disabilities and offers care management, in-home nursing, therapy and home health aide services to 40,000 New York Medicaid enrollees who live at home. The deal is expected to close during the second half of next year, pending regulatory review.

Anthem has been expanding its Medicaid footprint. This particular deal gives the insurer a toehold in home health and social determinants of health services, which could help the company improve patient outcomes and cut medical spending.

“The acquisition aligns with our goal of growing Anthem’s Medicaid business, while serving our members with a comprehensive and coordinated approach to care,” Felicia Norwood, executive vice president of Anthem’s government business division, said in a news release. “Like Anthem, Integra has established connections with community groups to gain a deeper understanding of how to best support the whole health needs of the people we are privileged to serve.”

The Integra Managed Care deal comes as Anthem’s government-sponsored business is expanding. During the third quarter ended Sept. 30, Anthem’s revenue grew 16% to $35.5 billion, driven primarily by growth in its Medicaid and Medicare operations.

Anthem’s Medicaid enrollees increased 21.1% to 10.3 million since the same period last year. The insurer is one of the largest Medicaid carriers and its enrollment is second only to Centene’s 14.7 million.

Anthem’s Medicaid growth came from new members gained through state partnerships, acquisitions and a regulatory pause on eligibility redeterminations.

North Carolina opened its Medicaid program to managed care companies for the first time this year, and Anthem captured 426,000 new members by joining that market. Anthem also won a bid to participate in Ohio’s Medicaid program, which covers 2.9 million people. And the company paid an undisclosed sum to buy MMM Holdings—the largest Medicare Advantage and second-largest Medicaid plan in Puerto Rico—this year, which added 572,000 policyholders to the company’s rolls.

Although Anthem’s Medicaid business is expanding, the insurer expects the boom to eventually bust once states begin reevaluating Medicaid enrollees’ eligibility at the end of the year.

Almost 90%, or 15 million, of the people who gained Medicaid coverage during the COVID-19 pandemic could lose benefits once the public health emergency ends because their incomes changed during the period when states paused eligibility reviews, according to a report from the Urban Institute.

By the second quarter of 2022, Anthem anticipates its Medicaid population to decline 65%, with about 45% of people returning to employer-sponsored coverage and 20% becoming eligible for subsidized private coverage from the health insurance exchanges. As these Medicaid members seek new sources of coverage, Anthem aims to convert them to other, more profitable products.

“We may be able to turn that headwind into a tailwind depending on where those folks go,” Chief Financial Officer John Gallina told analysts during the company’s third-quarter earnings call last month. “We do believe that once redetermination starts that we will be able to maintain a significant amount of that membership within an Anthem product.”


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