Booz & Company created estimates based on interviews with state Medicaid directors, policy analysts and health plan executives as well as state-level projections and modeling. Sanjay Saxena, MD, partner with Booz & Company, led the study.
The study also projected that by 2019, the number of Medicaid beneficiaries in risk-based managed care could almost double, from 26 million to 47 million. The market size of Medicaid managed care would balloon to almost $355 billion, according to the report.
Dual eligibles, or those who qualify for both Medicaid and Medicare, also are growing market opportunities for managed care organizations. Booz & Company estimated the dual eligible market could be as high as $183 billion within the next five years.
While the expanding Medicaid and dual eligible markets present an opportunity with billions of dollars in play for MCOs, the study said “there are serious challenges and complexities” that MCOs should consider before jumping into the market, such as identifying which states have chosen or may choose to expand Medicaid under the Patient Protection and Affordable Care Act.
More Articles on Medicaid:
Utah’s Inspector General Wants Clearer Strategies on Medicaid Overhaul
CMS: States Can Opt Out of Medicaid Expansion After Opting in
Massachusetts: Medicaid Managed Care Pays Hospitals More
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