The imminent major Medicaid disenrollment due to changes in federal regulations given the end of the Public Health Emergency (PHE), termed “The Great Redetermination,” is projected to significantly reduce Medicaid revenues for health plan providers. These changes could affect up to 15 million Americans who are expected to lose their Medicaid coverage, thus directly impacting health plan revenues. Furthermore, a recent survey found that 83% of health plans are anticipating a decline in their Medicaid revenues, and 66% are preparing for an increase in medical-loss ratios due to the expected rise in the healthcare needs of remaining members. However, to help offset these losses, health plan leaders are advised to promptly adopt holistic cost-of-care strategies. These strategies include reviewing payment systems and processes for accuracy, scrutinizing medical and care management services, and revisiting drug cost management. Such measures will ensure that prices paid are accurate, services are medically appropriate and necessary, and prescription drug costs are effectively managed.

To learn more about these critical cost-of-care strategies and how health plans can navigate the challenges of “The Great Redetermination,” click here to read the full article, originally published in Managed Healthcare Executive.