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Centene Medicaid Dominance Continues with Delaware Expansion

Analysis  |  By Laura Beerman  
   July 18, 2022

The insurer now holds Medicaid contracts in 30 states, representing nearly 25% of total market share.

Centene now holds Medicaid business in 30 states with its most recent award in Delaware, announced last week.

Centene is the nation's largest Medicaid insurer, with more than 15 million members, including four of the largest states: California, Florida, New York, and Texas. In Q1 2022, Louisiana and Indiana re-awarded its statewide Medicaid MCO contracts to Centene 

In the company's press release, Centene CEO Sarah London stated: "We look forward to building on our nearly 40 years of Medicaid experience to improve health outcomes for Delaware residents and provide better value to the state."

The Centene award expands Delaware's Medicaid MCO count to three. Highmark Health Options Blue Cross Blue Shield has been in the state since 2015 and AmeriHealth Caritas since 2018.

In an agency release, Delaware Department of Health and Social Services Secretary Molly Magarik stated: "These companies not only will offer more choice to our Medicaid members, but they also understand Delaware’s commitment to value-based care, and to the critical services that our Medicaid members need and deserve."

Delaware Medicaid overview

Diamond State Health Plan (DSHP) is the name of Delaware's Medicaid program, which integrates physical, behavioral, and long-term care, the latter as a part of DSHP-Plus. Total enrollment is roughly 300,000.

Delaware is one of only a few states with all-payer benchmarks — Medicaid, Medicare, and commercial insurers — for quality and spending. Delaware is also a Medicaid expansion state, with Medicaid/CHIP enrollment increasing nearly 24% during the pandemic (February 2020–March 2022) per data published by the Kaiser Family Foundation.

President and COO Brent Layton added: "It is a privilege to be selected by the state of Delaware to provide local healthcare services and programs that address social determinants of health and remove barriers to care for Medicaid members across the state."

Centene's Medicaid projections

While Q2 2022 performance is forthcoming, Layton anticipated the following in Centene's first-quarter investor call:

  • Redeterminations: "Our Medicaid growth continues to be aided by the ongoing suspension of redeterminations … [W]e anticipate the return of redeterminations in August … and are confident in our ability to retain and attract membership."
  • Exchange business: "So [in] the 29 states where we have Medicaid health plans, we have the exchange or our Ambetter product in 25 of them. So we're able to overlap the counties and in a lot of ways, overlap the provider network."
  • Medicaid pipeline: "There's no doubt the Medicaid RFP pipeline is reopening. It's much more like a 2017, '18 and '19 … [W] we have prepared for these [reprocurements] … But we also see a lot of new opportunities."

Layton cites Centene's close relationships in the states where it does business, commenting in the Delaware award release: "We are excited to work with the state and providers on proven models of value-based care to deliver transformative healthcare and improve the health of Diamond State Health enrollees."

Laura Beerman is a contributing writer for HealthLeaders.


Delaware awarded contracts to Centene subsidiary Delaware Health First and two existing MCOs, effective January 2023.

This further expands Centene's Medicaid market share, which was already the largest in the U.S.

While Q2 2022 performance news is pending, Centene sees opportunities for both renewals and new wins.

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