Medicaid Plans Accelerate Decline in Core Administrative Costs

PHILADELPHIA--(BUSINESS WIRE)-- Core administrative expenses of Medicaid plans fell by 5.2% per member per month (PMPM) in 2009 versus a decline of 1.4% in 2008. After eliminating the effects of changes in product mix, PMPM costs declined by 5.8% in 2009 versus 2.7% in 2008.

Declines in Account and Membership Administration costs were chiefly responsible for the overall declines. For the universe of Medicaid plans submitting 2009 data, core administrative expenses comprised 7.0% of premium equivalents compared with 8.0% for plans submitting data for 2008.

These results are excerpted from the 2010 Medicaid edition of the Sherlock Expense Evaluation Report (SEER). The universe included ten Medicaid plans, which together served 3.9 million members of which, on average, 70.8% were in Medicaid HMO.

Medicaid programs are squeezed between higher enrollment and state budget limitations. The weak economy has led to increased Medicaid eligibility and lower state tax revenues. Under health care reform, the number of Medicaid-eligible individuals is expected to increase by 16 million people.

According to Douglas B. Sherlock, CFA, Sherlock Company’s president, “This year’s decline in costs builds on last year’s. The 13% per member decline in Account and Membership Administration compounds the 6% decline in the prior year.”

The Medicaid universe is one of several surveyed by Sherlock Company in developing its benchmarks. Other universes include Independent/Provider-Sponsored plans, Blue plans, TPAs and Medicare plans. Collectively, the 58 plans serve approximately 44 million insured Americans.

Additional information was published Friday in Plan Management Navigator, available upon request or see our website, The complete analysis is available in SEER. Please call for additional information.

We will host a web conference on Tuesday, October 12 from 2:00 PM to 3:00 PM East Coast Time to discuss the summary results. Doug Sherlock will offer a brief presentation, followed by questions and answers. To participate in the web conference, please register at:

Once registered, dial-in information and a link to connect to the web will be provided in a confirmation email.

Sherlock Company (, based in Gwynedd, Pennsylvania, provides informed solutions for health plan financial management. Since its founding in 1987, Sherlock Company has been known for its impartiality and technical competence in service to its clients.


Sherlock Company
Douglas B. Sherlock, CFA
[email protected]

KEYWORDS:   United States  North America  Pennsylvania

INDUSTRY KEYWORDS:   Health  Professional Services  Insurance  General Health  Managed Care