February 9, 2023
Prior to the COVID-19 Pandemic, Texas Medicaid enrollment was approximately 3.1 million (as of December 31, 2019). With the implementation of the Public Health Emergency in early 2020 and the continuous Medicaid coverage requirements that followed, enrollment would expand 75% to cover nearly 5.3 million Texans, as of September 30, 2022. Over 35% of Texas’s Medicaid enrollment is in three counties. In this brief, Mark Farrah Associates (MFA) analyzes Medicaid enrollment figures from County Health CoverageTM for Harris (HAS), Dallas (DAS), and Bexar (BEX) Counties in Texas, with a focus on health plan market position.
Competition and Market Share
As of September 30, 2022, approximately 5.3 million people were enrolled in Medicaid plans in Texas. Out of seventeen Medicaid providers in the state, eight companies cover at least 200,000 Texans, representing a combined total of 4.4 million people, about 83% of the state’s total Medicaid market. The graph below illustrates market share for the five leading companies state-wide. Centene, Elevance (formerly Anthem), and Texas Children’s Health Plan are the three largest Medicaid providers in Texas, covering 54.6% of Texans. For 3Q22, Harris Health continued to hold its fourth place ranking, but the other top five companies experienced greater increases in enrollment from last quarter.
The top three counties in Texas, based on Medicaid enrollment, are Harris, Dallas, and Bexar. With 940,000 enrollees, Harris County, part of the Houston metropolitan area, has the largest Medicaid enrollment in the state. The graph below shows market share for the top Medicaid companies in Harris County, as of September 30, 2022 (3Q22). Texas Children’s Health Plan provides coverage for over 42% of the county’s market.
Representing nearly 520,000 in total Medicaid enrollment, Dallas County has the second largest Medicaid enrollment in the state. Elevance leads in this area with 46% share of the market. Parkland Community Health Plan and Molina each cover 34% and 13%, respectively. Ascension Health has gained enough Medicaid enrollment in Dallas County to move into the top five plans in the area.
Bexar County, located in the San Antonio area, is the third largest in the state for Medicaid enrollment, with over 400,000 insured residents. Centene accounts for nearly half of the county’s market with 184,000 enrolled (46%). Community First (36%) and CVS (9%) represent another equivalent portion of the county and, when combined with Centene, provide Medicaid coverage to almost 91% of Bexar County.
With the federal government’s continuous Medicaid coverage requirement set to end on March 31, 2023, the Texas Health and Human Services Commission has implemented a year-long “unwinding” plan of renewals[i], redeterminations, and disenrollments[ii]. Considering the size and recent growth of the Texas Medicaid market, evaluating market share in response to these changing laws and redeterminations will be an important measure of competitive positioning and health plan performance for insurers. Mark Farrah Associates will continue to monitor Medicaid enrollment across the state of Texas and the country, using County Health CoverageTM and integrating highly relevant sources to provide reliable estimates of health insurance market share at these levels.
About County Health CoverageTM
County Health CoverageTM provides reliable estimates of health insurance enrollment and market share at the state, county, and Metropolitan Statistical Area (MSA) levels. Product features include company market share by county, company, and state for the Private Risk, Private Administrative Services Only (ASO), Managed Medicaid, Medicare Advantage, and stand-alone Prescription Drug Plan (PDP) segments. Breakdowns by product type (HMO, PPO, etc.) are also presented, as well as population demographics and interactive, visual mapping tools. To learn more, visit the product page - County Health CoverageTM.
About Mark Farrah Associates (MFA)
Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.
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[i] HHSC Urges All Medicaid Recipients to Update their Contact Information as Continuous Medicaid Coverage Requirement Ends| Texas Health and Human Services Commission (HHSC). https://www.hhs.texas.gov/news/2023/01/hhsc-urges-all-medicaid-recipients-update-their-contact-information-continuous-medicaid-coverage
[ii] Ending Continuous Medicaid Coverage January 2023 | Texas Health and Human Services Commission (HHSC). https://www.hhs.texas.gov/sites/default/files/documents/feb-2023-hpac-agenda-item-3.pdf