Category: Medicaid Managed Care

Alternative Headline: Judge Upholds Medicaid Insurer Ban

[MM Curator Summary]: A Minnesota judge upheld a state law excluding for-profit insurers like UnitedHealthcare from its Medicaid program, affecting 32,000 enrollees. 

========================================

A Minnesota judge has ruled against UnitedHealthcare in a lawsuit challenging a Minnesota law barring for-profit insurers from the state’s Medicaid program. 

In a decision issued June 30, Minnesota District Court Judge Mark Ireland ruled the statute, passed as part of a “jumbo-omnibus” at the end of 2024, stands. 

In August 2024, UnitedHealthcare filed a lawsuit alleging the way the law was passed as part of a package including unrelated provisions violated the Minnesota constitution. The judge ruled the Medicaid provisions were germane to the bill’s title. 

The state terminated UnitedHealthcare, the only for-profit insurer in its Medicaid program, at the end of 2024. Minnetonka, Minn.-based UnitedHealthcare managed care for around 32,000 Medicaid enrollees, a small slice of Minnesota’s 1.4 million Medicaid beneficiaries. 

In a statement shared with Becker’s, UnitedHealthcare said the company is “disappointed with this ruling” and evaluating its options. 

“UnitedHealthcare was unfairly removed from its hometown Medicaid program, which limited the options available to the citizens of Minnesota. Meanwhile, Minnesotans have had their options further restricted by other health plans choosing to leave the Medicaid program. The ruling continues to limit choice for individuals, families and children in Minnesota,” the company said. 

In May, Bloomington, Minn.-based HealthPartners scaled back its Medicaid operations, exiting Minnesota’s Special Needs Basic Care Medicaid program and pausing enrollment in other plans. 

Next Up in Legal

• UnitedHealth Group is complying with criminal and civil investigations into its Medicare Advantage business, the company said in a July…
• Humana has reintroduced a lawsuit challenging its Medicare Advantage star ratings.  On July 18, U.S. District Judge Reed O’Connor dismissed…
• Attorneys representing Luigi Mangione, the man accused of killing UnitedHealthcare CEO Brian Thompson in late 2024, have accused the Manhattan…

https://www.beckerspayer.com/legal/unitedhealthcare-loses-challenge-over-minnesota-law-banning-for-profit-medicaid-plans/

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

COLOR CODE: 

General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE

Alternative Headline: AmeriHealth Caritas Posts $199M Loss

[MM Curator Summary]: AmeriHealth Caritas posted a $199 million loss in 2024 as Medicaid enrollment shrank after pandemic protections ended, and new legislature threatens even further losses. 

==============================

IBX’s AmeriHealth Caritas lost money for the first time in five years as Medicaid enrollment declinedThe Medicaid insurer, jointly owned with Blue Cross Blue Shield of Michigan, had its first annual loss since 2019.by Harold BrubakerPublished June 11, 2025, 5:00 a.m. ETIBX’s Medicaid unit, AmeriHealth Caritas, had a net loss of $199 million last year, a sharp swing from a $368 million profit in 2023. Enrollment declined as COVID-era Medicaid rules ended.The loss, reported in the audited financials statements of Independence’s partner Blue Cross Blue Shield of Michigan, was the first for AmeriHealth Caritas since 2019, when the company lost $200 million.Its five-year streak of double-digit revenue increases also came to an end, as Medicaid enrollment declines and a failure to win certain new state Medicaid contracts hurt results. The Newtown Square-based company’s revenue climbed just 3%, to $24.3 billion, last year.In an emailed statement, AmeriHealth Caritas attributed last year’s disappointing financial results to industrywide challenges. During the federal COVID-19 public health emergency, individuals did not have to reapply for Medicaid benefits. They could keep the government-funded health insurance benefits even if they did not still qualify.» READ MORE: AmeriHealth Caritas lays off administrative staff as Medicaid enrollment fallsIn Pennsylvania, Medicaid enrollment ballooned from 2.2 million people in early 2020 to a peak of 3 million in the spring of 2023. By April, the statewide figure had fallen to 2.4 million. AmeriHealth Caritas’ enrollment had an even bigger percentage decline in Pennsylvania, it’s biggest market.Insurance executives at AmeriHealth and other companies have said that the people who maintained Medicaid coverage were sicker on average than those who lost coverage. That meant that the rates the Medicaid insurers received from states didn’t reflect how much care Medicaid beneficiaries needed, according to the industry.“We are working with our state partners to close the gap in 2025 as we remain focused on opportunities that ensure our members can get the care they need and stay well,” AmeriHealth Caritas’s statement said.Now, AmeriHealth Caritas and other Medicaid management companies are facing the potential loss of many thousands more customers if Congress follows through with proposals to make harder for people to keep Medicaid by imposing work requirements and making other changes to the program.

https://www.inquirer.com/health/ibx-amerihealth-caritas-medicaid-loss-2024-20250611.html