Medicaid Managed Care: Top Five Companies in Fourth Quarter 2024
The earnings results for the top five publicly held companies dominating the Medicaid managed care market in the fourth quarter of 2024 have been analyzed. These companies, often referred to as the “Big Five,” are Centene, CVSHealth/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group. Although there are other non-profit Medicaid managed care organizations with regional or single-state market presence, they do not report earnings publicly, so their results are not included in this analysis. Overall, the “Big Five” saw a stabilization in net Medicaid enrollment after a period of decline. Company executives expressed concerns about the discrepancy between capitation rates and the complexity of the remaining enrollees. During the earnings calls, only one CEO explicitly addressed this challenge.
According to Fig. 1, the Medicaid enrollment numbers for all five companies were tracked from the start of the COVID-19 Public Health Emergency in March 2020 until the conclusion of the PHE continuous enrollment period in April 2023. By December 2024, following the completion of eligibility redeterminations by most states except North Carolina and the District of Columbia, the total net Medicaid enrollment for the “Big Five” was 36.8 million. This figure represented a 17% decrease from the peak enrollment of 44.2 million in March 2023 but a 22% increase from the 30.1 million enrollees at the beginning of the PHE. It is important to note that the overall increase in “Big Five” enrollment across the country since the start of the PHE masks variations in Medicaid program participation rates from state to state, a point highlighted by Joan Alker and her research team.
The data provided by these earnings results shed light on the evolving landscape of Medicaid managed care and the challenges faced by key players in the industry. The stabilization of net Medicaid enrollment among the “Big Five” reflects a complex interplay of factors, including the impact of the PHE, state-based program changes, and company-specific strategies such as acquisitions and divestitures. Company managements’ concerns about the adequacy of capitation rates to support the care needs of enrollees highlight a critical issue that continues to be a focal point in discussions within the industry.
As the Medicaid managed care market continues to evolve, stakeholders must closely monitor key indicators such as enrollment trends, regulatory changes, and financial performance to navigate the shifting landscape effectively. The “Big Five” companies play a significant role in shaping the future of Medicaid managed care, and their strategic decisions and operational outcomes will have implications for millions of enrollees across the country. By examining the quarterly earnings results of these major players, industry observers and policymakers can gain valuable insights into the opportunities and challenges facing Medicaid managed care in the coming years.
