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Medicaid redetermination and MCO oversight: Maryland reports strong retention but rising costs, reviews Kaiser financials
Summary
Medicaid officials told the Finance Committee the state retained a high share of beneficiaries during the post‑pandemic redetermination process and increased accountability requirements for managed care organizations, while noting enrollment-driven cost pressure and ongoing review of Kaiser financial reports for 2025 rate‑setting.
Maryland Medicaid officials briefed the Finance Committee Thursday on the state’s post‑public‑health‑emergency redetermination work, managed care oversight and a recent MCO contract issue with Kaiser Permanente.
Dr. Ryan Moran, principal Medicaid official in the Maryland Department of Health, told senators the state used flexibilities and monthly cohorts during the unwinding of continuous enrollment and that Maryland was “one of the top” states for coverage retention; he said roughly 70% of reviewed cases retained eligibility after the first full year of renewals. Moran said enrollment peaked near 1.8 million during the pandemic and is now roughly 1.6 million.
Officials said several factors are driving higher Medicaid costs: pent‑up demand and higher clinical acuity among enrollees after the pandemic, new FDA‑approved drugs for indications such as obesity and expanded federal coverage rules for children and other groups. Moran said the Medicaid program and the department have increased accountability for managed care organizations (MCOs), including requiring NCQA health equity accreditation, key senior staffing in state operations, and stronger requirements for care coordination (justice‑involved youth, social‑determinants screening, maternal child health).
On Kaiser, Moran described fall 2023 contract negotiations that required additional financial reporting from Kaiser so actuaries could evaluate Kaiser alongside the other nine MCOs during 2025 rate setting. He said the department and actuarial contractor Myers and Stauffer have negotiated reporting requirements for calendar year 2025 and that staff are currently reviewing Kaiser’s financial submissions.
Committee members also raised provider payment problems tied to a claims processing transition. Several senators reported constituent providers still awaiting payments after the Optum to Carillon transition; Moran said the cutover began Dec. 22 and that some provider delays were caused by providers not having completed new Carillon provider IDs. He said the state has relaxed prior authorizations for January and that weekly check runs are meeting more than 70% of typical weekly payments while MDH and Carillon work to enroll remaining providers.
Moran closed by thanking Medicaid staff and repeating the program’s scope: roughly 25% of Marylanders are enrolled and 96% of Medicaid dollars go to care and services, he said. The committee did not take any formal votes.
