The number of people determined eligible for Medicaid since the launch of new insurance marketplaces is approaching 10 million, a potential boon to managed care plans and safety providers even in states that are not expanding the program.
Between October and February, 8.9 million adults and children have applied and qualify for Medicaid and CHIP, including people in income brackets newly eligible for Medicaid and those eligible prior to health reform, according to new data released from the Centers for Medicare and Medicaid Services. Many of those may very well be people renewing coverage; it not yet clear how many represent new enrollees.
About 4.6 million people determined eligible are from the 26 states expanding Medicaid eligibility and about 4.3 million are from the others not expanding. In every state, at least some of them are likely "coming out of the woodwork," people already eligible who are now applying amid all the new promotion and media coverage of the Affordable Care Act.
Among those determined eligible are some 653,000 Floridians and 1.5 million Texans.
In those two states, many new beneficiaries are enrolling in managed care plans administered by several large insurers and not-for-profit health plans. They're also likely to be eyed by public hospitals and federally qualified health centers -- and in some cases they'll be covered by managed care organizations launched by an FQHC.
This year Florida is transitioning almost all of its 3 million Medicaid beneficiaries to managed care plans sponsored by established payers like Amerigroup, Centene, Humana and UnitedHealth, as well as some up- and-comers.
The Jessie Trice Community Health Center, an FQHC with 16 facilities, is covering Medicaid beneficiaries in eight of Florida's eleven Medicaid regions, including greater Miami, through a for-profit plan, Prestige Health Choice, that it created in 2008.
The Jessie Trice Community Health Center's move to launch its own Medicaid plan -- officially called a provider service network, as opposed to an HMO -- has garnered a fair amount of interest from other Florida health payers and providers.
Florida Blue and AmeriHealth Caritas ended up buying a 40 percent stake in Jessie Trice's Prestige Health Choice through a partnership called Florida TrueHealth, while Florida Health Choice Network, a consortium of 23 community health centers and FQHCs, took a 13 percent stake.
Three other provider service network Medicaid plans are taking part in the managed care transition, including First Coast Advantage, a Medicaid plan created by University of Florida Health, in the region serving greater Jacksonville, and Integral Health Plan, sponsored by Healthcare Network of Southwest Florida and the Association of Area Delivery Systems, a group of FQHCs, in two regions on the southwest coast of Florida.
Centene's Sunshine State Medicaid plan is covering beneficiaries in nine regions, WellCare's Staywell in eight, Humana in five, and Amerigroup and United each in four.
Meanwhile, FQHCs everywhere, regardless of Medicaid expansion, are facing a sort of funding cliff. The federal Health Center Fund is set to expire at the end of fiscal year 2015, leading to what the the National Association of Community Health Centers expects will be a 70 percent reduction in health center funding.
The National Association of Community Health Centers is hoping to build support for President Obama's proposal to continue the Health Center Fund through 2020.