The growth of Medicaid Managed Care Organizations (MCOs) in the United States

Enrollment in Medicaid and Managed Care Organization (MCO) plans in the United States has reached an all-time high of 74 million recipients. According to Health Affairs, “an estimated 71 percent of Medicaid recipients are receiving their care via private health plans, both investor-owned and nonprofit.” In 2016, research behind the shift showed that managed care plans can provide services that state Medicaid agencies cannot fulfill. For example, network contracting, information technology, and use of management systems to display low-value care can vastly improve the health of beneficiaries. 

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Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.  

In our new whitepaper former Executive Director for Aetna’s Exchange program and Founder, JGood Advisors, Jane Good discusses Enhanced Direct Enrollment (EDE) and this new policy strategy.

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New York SHOP program removes online enrollment & premium billing

Starting this month, NY State of Health (NYSOH) made several changes to the state’s SHOP program in an effort to give the federal tax credit to as many small businesses as possible.   

In New York, 98% of businesses have fewer than 100 employees and over 40% of the workforce is employed in these small businesses. The recent changes impacting these businesses were allowed through the November 2017 rule that allows small employers to enroll directly through issuers and brokers and still receive the small business tax credits.  

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