Tufts Health, Harvard Pilgrim plans drumming up out-of-state Medicaid business


Looking to expand their market reach and beef up business, two nonprofit insurers in Massachusetts are considering entering out-of-state markets, including possibly partnering with other insurance companies, reported The Boston Globe.

Tufts Health Plan and Harvard Pilgrim Health Care are in a unique position, having operated throughout the Massachusetts health reform overhaul, which included an individual mandate and a statewide health insurance exchange. Both insurers likely will target Rhode Island, Maine and New Hampshire, all of which have locally high uninsured rates.

Expanding out of the Massachusetts market could help Tufts and Harvard Pilgrim compete against Blue Cross Blue Shield of Massachusetts, which is banned from selling insurance in other states by the national Blues association. The two nonprofit insurers have kept their eye on Blue Cross and last year even considered merging to better compete against the state's market leader.

"Conceivably the expertise we've developed here could be useful in other states," Tufts CEO James Roosevelt Jr. told the Globe. "Particularly in the subsidized and Medicaid markets, we're considering other states."

Tufts will decide by next year whether it will expand into other states' Medicaid and individual insurance markets and may consider establishing partnerships with insurers in other states, Roosevelt added.

"It's a very strong opportunity, especially for regional health plans like ours that are connected to the local markets," Harvard Pilgrim CEO Eric Schultz said. However, he noted that the amount of potential business "is going to be directly impacted by state-level decisions on how they define the range of individuals who are eligible for Medicaid and subsidized insurance."

To learn more:
- read the Boston Globe article

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