Administrative Cost Trends of Medicaid Focused Plans

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.6% in 2021, a deceleration from 2020’s increase of 5.8%. Similarly, the Account and Membership Administration decelerated by 4.2 percentage points, from 5.5% to 1.3%. The rates of change reflected here hold both surveyed plans and their product mix constant in each year-over-year comparison. Cost trends in 2021 for both Core and Account and Membership Administration were below average, both of which were approximately 4%, since 2010. The cost trends for 2021 discussed are based on the results of ten continuous plans serving 11.2 million members in comprehensive products, of which 6.3 million were Medicaid or CHIP.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data.

Event Date: Thursday, October 13, 2022

Event Webpage (Available for subscribers only)

Category(s): Health Plans, Medicaid 

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