Of late, the number of patients insured by Medicaid HMOs has climbed substantially, and investor interest in this industry has spiked. Leaders in the Medicaid HMO marketplace, which include WellCare Health Plans, Centene, Molina Healthcare and Amerigroup, have seen patient enrollee volumes climb dramatically in recent times. The number of Centene enrollees, for example, climbed from 142,000 members to 1.2 million members over the past six years. Because states pay Medicaid HMO firms only 80 to 85 percent of what they spend on indemnity plans, the concept can be a big cost-saver. However, critics are increasingly questioning whether these plans are inappropriately limiting member access to care. Amerigroup, for its part, was recently fined $144 million when it was found to have discouraged pregnant women from enrolling. Other observers say Centene is making it extremely difficult for patients to get basic screenings, for example, by requiring approvals for standard measures such as chest X-rays in cases of suspected pneumonia. However, extensive research on the overall quality of care provided by Medicaid HMOs still hasn't been done.
For more background on the Medicaid HMO business:
- read this article in the Wall Street Journal (sub. req.)