Mark Lutes Quoted in Article, "How Does Reform's Medicaid Provision Impact Payers?"

Although the Supreme Court largely left the health reform law intact and constitutional, it made a minor change to the Medicaid expansion provision. Namely, the high court decided that the federal government can offer funds for states to expand Medicaid coverage to new individuals and that states accepting such funds must obey by the accompanying rules. However, the federal government can't withhold all Medicaid funds from states that refuse to expand their Medicaid population. ?...

But despite the uncertainty surrounding Medicaid expansion, "It's potentially a very fruitful, very opportunity-filled landscape for plans that already have care management capabilities appropriate to the Medicaid population," Mark Lutes told FierceHealthPayer. Therefore, he recommended that insurers track states' Medicaid activities and help work with state policymakers to bring a solution to the market, including encouraging a switch to private managed care.

"From a managed Medicaid population perspective, it's a very active time," and health plans operating in the Medicaid market have "a lot of public policy work to be doing right now" if they want to be considered by the increasing number of states that are putting additional portions of Medicaid enrollees into coordinated care plans, Lutes said.

"That sector has the potential to become even immensely more attractive and interesting" for insurers, he added, because the risk-adjusted payment per member, per month to handle those enrollees will be "relatively rich." So there's a "large opportunity to make a decent return for those health plans that are able to design care management programs that can deliver quality care for less than the large premium," Lutes said.