Administrative Cost Trends of Medicaid-Focused Plans in 2022

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.4% in 2022, slower than the growth in 2021 at 2.6%. The Account and Membership Administration accelerated to an increase of 5.7% in 2022, up from an increase of 1.3% in 2021.

This analysis is based on the twenty-first 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 about 1,000 health benefit organization 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. This analysis of Medicaid plans is based on a peer group of fifteen plans who collectively served 15.5 million people in comprehensive products. Ten of this year’s participants also participated in the prior year. The average plan participating in the Medicaid Sherlock Benchmarks this year served 1.0 million people under comprehensive products and the median membership was 675,000. The geographic reach of this universe extended from coast to coast.

Event Date: Wednesday, October 11, 2023

Event Webpage (Available for subscribers only)

Category(s): Health Plans, Medicaid , Popular

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