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1913 Atlantic Ave., Suite F4
Manasquan, NJ  08736
(732) 292-1100
fax: (732) 292-1111


MCIC Press Release

For more info, contact MCIC:
Phone: (732) 292-1100
Fax: (732) 292-1111
Email: info@themcic.com

Hot Off The Press

For-Profit Medicaid MCOs Outnumber Not-For-Profits

Manasquan, N.J. -- Managed care organizations (MCOs) that offer Medicaid coverage are more likely to be for-profit than not-for-profit, according to a new Managed Care Information Center study.

But statistically, the study shows, the not-for-profits have the potential to serve a majority (78.5 percent) of Medicaid enrollees, and the ratio of Medicaid enrollees per MCO is greater for not-for-profits.

Of the 422 MCOs in the study, 384 (91 percent) indicated whether they were for-profit or non-profit. Of those, 56 percent (215) said they were for-profit; 44 percent (169) said they were not-for-profit. Among them are such publicly held companies as Aetna Inc., CIGNA Corporation, Oxford Health Plans and WellPoint Health Networks Inc.

Of the nation’s estimated 40.3 million Medicaid enrollees, each not-for-profit could serve roughly 239,000, but each for-profit could serve 187,819.

Regional Count

Regionally, the most for-profits — 68, or nearly 32 percent — are in the North Central area of the United States, which consists of Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, South Dakota and Wisconsin.

The South Atlantic region, which contains the District of Columbia, West Virginia, and the coastal states from Delaware to Florida, is a distant second, with 39 for-profits, or 18 percent.

Regional Rankings by Total Medicaid MCOs

Region *

For-Profits

Not-For-Profits

Unknown

Total Medicaid MCOs in Region

North Central

68

41

16

125

Mid-Atlantic

33

34

7

74

Pacific

21

32

5

58

South Atlantic

39

9

4

52

South Central

28

13

5

46

Mountain

20

11

2

34

New England

6

9

0

15

Source: The Managed Care Information Center, 2001.

* Note: Mid-Atlantic: New Jersey, New York, Pennsylvania.

Mountain: Arizona, Colorado, Idaho, Montana, New Mexico, Nevada, Utah, Wyoming.

New England: Connecticut, Maine, Massachusetts, New Hampshire, Vermont.

North Central: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, South Dakota, Wisconsin.

Pacific: Alaska, California, Hawaii, Oregon, Washington.

South Atlantic: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia.

South Central: Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, Texas.

The Mid-Atlantic region — New Jersey, New York and Pennsylvania — is third, with 15 percent, or 33.

Of the not-for-profit Medicaid MCOs, nearly one-third (54) are in the Mid-Atlantic, followed by North Central with slightly less than 25 percent (41), and the Pacific region — Alaska, California, Hawaii, Oregon and Washington — with 19 percent (32).

The region with the most Medicaid MCOs — for-profit, not-for-profit and unknown — is North Central, with 125 (29.5 percent), followed by the Mid-Atlantic with 74 (17.5 percent), and the Pacific with 58 (14 percent).

The areas with the fewest Medicaid MCOs are New England and the Mountain region, which contains Arizona, Colorado, Idaho, Montana, New Mexico, Nevada, Utah and Wyoming. Each region has 15 MCOs, or 3.5 percent.

State Stats

The states with the most for-profit Medicaid MCOs are:

* Texas — 17, or nearly 61 percent of the South Central’s 28 for-profits;

* Florida — 17, or 43.5 percent of the South Atlantic’s 39 for-profits; and

* California — 16, or 76 percent of the 21 for-profits in the Pacific region.

The states with the most not-for-profits are:

* New York — 29, or 85 percent of Mid-Atlantic not-for-profits;

* California — 20, or 62.5 percent of the Pacific-not-for-profits; and

* Michigan — 14, or 34 percent of the North Central’s not-for-profits.

The states with the most Medicaid MCOs, for-profit, not-for-profit and unknown, are:

* New York — 43, or 58 percent of the 74 Mid-Atlantic MCOs;

* California — 39, or 67 percent of the Pacific’s 58 MCOs; and

* Michigan — 32, or nearly 26.50 percent of the North Central’s 121 MCOs.

States With the Most Medicaid MCOs

State

Total

New York

43

California

39

Michigan

32

Texas

26

Illinois

23

Florida

22

Pennsylvania

21

Wisconsin

18

Source: The Managed Care Information Center, 2001.

Room for More Business

The amount of Medicaid enrollees compared with the number of MCOs within individual states suggests room for more MCOs to serve the population, although, historically, health plans contend that government reimbursement rates are hardly worth the effort.

For example, according to the most recent figures by the Centers for Medicare and Medicaid Services (CMS), California in 1998 had 6.1 million of the Pacific region’s 7.8 million Medicaid enrollees. It is unknown how many MCOs served the Medicaid population that year. But considering the fluidity of enrollment and the number of current Medicaid MCOs, the ratio of enrollees to MCOs in California could be as high as 160,000 to 1.

The states with the potential for the highest enrollee-to-MCO ratios are in the South Atlantic region: South Carolina, 656,000 to 1, and North Carolina, 601,000 to 1.

The state with the smallest ratio is New Jersey, with 8,580 to 1.

Regionally, in 1998, the North Central region held nearly 20 percent of all Medicaid enrollees. The Pacific had 19 percent; the South Central, slightly more than 17.5 percent.

Address: The Managed Care Information Center, 1913 Atlantic Ave., Suite F4, Manasquan, NJ 08736; (732) 292-1100, www.themcic.com.


For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail info@themcic.com or online at http://www.themcic.com.

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