UPMC sees 10% Medicaid enrollment growth, slimmer insurance margin

UPMC Health Plan’s Medicaid enrollment grew almost 10% year-over-year, even as commercial enrollment declined, the insurer’s parent company disclosed Tuesday.

UPMC’s financial statement for the nine months ended Sept. 30 shows the health plan covered 557,000 Pennsylvania Medicaid beneficiaries as of that date, which is nearly 50,000 more than a year before. Meanwhile, the Pittsburgh-based company’s commercial enrollment fell 4% to 659,000. The insurance division’s Medicare customer base grew 2.5% to 200,738. UPMC’s total health plan membership stood at just over 4 million.

UPMC Health Plan’s operating income fell $206 million and its operating margin was 1.6% during the first nine months of this year, down from 4% compared to the same period in 2020. Rising medical claims from patients seeking care they delayed last year because of the COVID-19 pandemic accounts for the smaller margin, according to the company’s financial report. A UPMC spokesperson said no one was available to comment Wednesday.

UPMC’s company-wide operating margin almost doubled to 4.4% during the first nine months of the year 2021 because of a stronger performance in its provider division. Outpatient revenue grew 17% and physician services and admissions also improved.

Medicaid enrollment has spiked during the pandemic largely because of a federal rule that prevents states from kicking people off their programs during the public health emergency, which Health and Human Services Secretary Xavier Becerra renewed for another 90 days on Oct. 15. More than 9 million working age adults and children gained coverage between February 2020 and January 2021 alone, and the Urban Institute estimates that will have grown to 17 million by the end of the year.

Banner Health in Phoenix similarly reported almost 14% higher enrollment in its Medicaid plans in the first nine months of 2021. The health system’s Medicaid plans posted an operating gain of $24 million during the period, surpassing the insurance division’s $16 million operating gain during the first three quarters of 2020.

Banner Health lost $15 million on operations for its Medicare Advantage contracts and made $7 million on its commercial plan joint ventures during the first nine months of 2021. The system’s overall operating margin was a slim 1.8%.

Large, for-profit health insurers have reported big jumps in Medicaid enrollment. Centene, the biggest Medicaid insurer, reported a 12% year-over-year increase in Medicaid membership to 14.8 million as of Sept. 30. Anthem, the second largest Medicaid insurer, saw 21% Medicaid growth to about 10.4 million as of Sept. 30.