Penn. Medicaid business draws limited national interest, expert cites strong BCBS presence

November 27, 2015

Pennsylvania's Medicaid market has grown substantially this year since Gov. Wolf expanded access to coverage, and nine companies have submitted bids to enter the state Medicaid market. Of these, only one of the new applicants seeking to offer managed care to lower-income Pennsylvanians beginning in 2017 is a national player: Centene. Other big national players - Anthem, Molina Healthcare and WellCare Health Plans - did not bid. Mark Cherry, principal analyst at Decision Resources Group, a healthcare data firm, says the state should theoretically be more attractive to Medicaid-focused insurers, since it has an established statewide mandatory managed Medicaid program coupled with the recent eligibility expansion,, but Cherry adds that the presence of strong regional BCBS companies, such as Independence Blue Cross, and hospital-owned insurers, including Health Partners Plans, are among factors that have "made it hard for outsider insurance companies to get a foothold in the state, or establish strong provider networks." The new Medicaid managed-care contracts will be awarded in five zones in January. The contracts will require insurers to better coordinate care, and pay hospitals and doctors based on the quality of outcomes rather than on the volume of procedures. Aside from Centene, the newcomers are Accenda Health, a subsidiary of Capital Blue Cross, Meridian Health Plan and Trusted Health Plan.