Lost in the hubbub over carriers that declined to participate in health exchanges are the carriers who have. Regional Medicaid plans already dealt with populations similar to those expected to seek exchange coverage. Now, in many states, those plans that once operated only Medicaid or dual-eligible populations could make a major statement among exchange purchasers.

Medicaid MCOS are a natural for exchanges. With much of the population floating between Medicaid and private exchange coverage?depending on their income status?those MCOs can provide continuity of care. Their previous experiences with high-cost Medicaid populations will serve them well when the newly enrolled arrive through the exchange with untreated health conditions and other issues.

One national carrier known primarily for Medicaid, Molina Healthcare, plans to sell individual exchange coverage in nine states where it operates Medicaid plans, including Florida, Michigan and its home state, California. Another, Centene, will use its Celtic subsidiary and state Medicaid plans in many states. At the moment, Centene's Magnolia Health Plan could be the sole option in the Mississippi health exchange.

At the AHIP Institute 2013's Exchange Conference, Molina officials reinforced that in covering high-risk populations, they had to know that population intimately.

Colorado Access, a longtime participant in Medicaid, Children's Health Plan Plus (the state's Children's Health Insurance Program) and Medicare Advantage, will apply that knowledge to the new population. Because of its status as a 501c4, a social welfare organization, Colorado Access formed a subsidiary, New Health Ventures, to sell individual policies in the Colorado exchange. ?We felt that having a product in the exchange was an extension of our public-sector products and could provide more seamless coverage,? says Gretchen McGinnis, Colorado Access? senior vice president of public policy and performance improvement.

In Rhode Island and Massachusetts, Neighborhood Health Plan will branch out from its Medicaid foundation and sell exchange policies.

Regional Medicaid carriers will have another advantage. Parents of children in Medicaid or CHIP have long sought coverage but found themselves ineligible. Parents of covered children commonly ask about the lack of affordable options, McGinnis says. Under the exchange and its subsidies, those parents could pick a plan from the carrier already covering their children through other programs.

These carriers might not make a major dent in exchange enrollment, but they could make a major dent in utilization and drug adherence for a sicker population expected to arrive first for exchange enrollment.

Follow Bill Melville on Twitter @BillMelvilleHLI

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