In April 2023, Texas began a redetermination period for Medicaid recipients following the end of the continuous coverage requirement. This report provides a comparison of state fiscal year (SFY) 2025 with prior years, providing insight into the impact of the effect of redetermination of Medicaid eligibility at the end of the Public Health Emergency (PHE). The redetermination period required managed care organizations (MCOs) to reassess member eligibility, resulting in significant declines in membership and net income across all programs.
The Texas Health and Human Services Commission publishes statutory financial statistical reports (FSRs) for managed care organizations (MCOs) contracting with the state to provide benefits under Medicaid and the Children’s Health Insurance Program (CHIP). Each FSR includes data for one of six programs and one of 13 service delivery areas. The Medicaid programs include the State of Texas Access Reform (STAR), STAR Kids, STAR+PLUS, CHIP, the Medicare-Medicaid Plan, and STAR Health. Milliman compiled the FSRs for SFYs 2019 to 2025. In this report, commissioned by the Texas Health and Human Services Commission, we summarize quarterly and annual financial results by program. We were able to see the impacts of the PHE on claim volumes, the impact of the PHE on membership and net income, and the impact of redetermination due to the ending of the PHE.
Key discussion points:
- Membership and revenue: A view of the two metrics over the fiscal years.
- Directed payment programs: Pass-through expenses as a percentage of gross and STAR medical expenses per member per month.
- Expense and net income: Medical loss, administrative expense, and net income ratios.
- Experience rebate: Estimated amount and impact on the net income ratio.
This report was commissioned by the Texas Health and Human Services Commission.