Medicaid Plans: The Battle for Market Share Is On. Are You Ready? 

Medicaid plans are under pressure like never before. Post-pandemic dynamics, shifting member expectations and mounting budget constraints have already created a challenging environment. Now, federal policy changes are tightening eligibility and reducing funding just as the competitive landscape is heating up.

The New Medicaid Battleground

The nation’s largest insurers — Centene, Molina, Elevance (formerly Anthem), UnitedHealthcare and Aetna/CVS Health — are aggressively expanding their Medicaid presence through RFP wins, state expansions and acquisitions. Even new entrants like TrueCare, a nonprofit that recently landed a statewide Medicaid contract in Mississippi, are shaking up the playing field.

We’ve helped plans grow enrollment by spotting emerging trends and identifying opportunities others overlook. For example, leading the state of Maryland’s efforts to build awareness and boost Medicaid renewals during the Unwinding period — an initiative that gave us valuable insights into member behavior and system challenges. It’s just one example of how plans can grow enrollment by identifying emerging trends and uncovering opportunities others often miss.

So what’s driving this current surge in Medicaid competition? Medicaid contracts are fast becoming a strategic asset due to the regulatory shifts that favor aligned D-SNP (Dual Eligible Special Needs Plan, a type of Medicare Advantage [Part C] plan designed specifically for people who are “dual eligible”— meaning they qualify for both Medicare and Medicaid).

The Centers for Medicare & Medicaid Services (CMS) is phasing in rules that will only allow D-SNPs affiliated with a Medicaid Managed Care Organization (MCO) to enroll dually eligible members.

• By 2027, nonaligned D-SNPs will lose mid-year enrollment rights.
• By 2030, members not enrolled in the affiliated Medicaid plan will be automatically disenrolled.

Did you know that every baby boomer will be 65 or older by 2030? And many will qualify for both Medicare and Medicaid, fueling a major surge in the D-SNP-eligible population. Along with capitalizing on the regulatory shifts, national insurers are aggressively expanding into Medicaid, aiming to offer both Medicare Advantage and Medicaid to own the full member journey from enrollment to end of life.

How Medicaid Plans Can Win in This New Era

To stay ahead of new entrant and aggressive competitors, you must act now. Here’s how:

1. Gain Market Intelligence

Medicaid member behaviors are shifting. During the redetermination period, many enrollees hesitated to shop or switch plans out of concern for coverage disruption. Now, with stability returning, members are actively comparing options and switching more frequently. Use in-depth qualitative research to understand what motivates members to join or leave your plan. These insights can inform more targeted marketing, onboarding and retention strategies.

2. Invest in Retention From Day One

Your current members are your most valuable asset, and they’re being targeted. The first 30 to 90 days is a critical window to build trust, reduce complaints and prevent churn.
Best practices include:

• Personalized welcome calls and texts
• Digital onboarding experiences
• Timely follow-up surveys and check-ins

3. Target Younger, Non-Dual Populations

Focus on low-income parents and families who can deliver longer-term value. Tailor your messaging and benefits to this group with a focus on:

• Maternal health support
• Pediatric and preventive care
• Childcare-related benefits

4. Modernize Your Advertising Strategy

You likely pulled back during redetermination. It’s time to ramp back up. Meet these younger members where they are:

• Social media and streaming platforms
• Mobile-first campaigns
• Local community events
• Invest in video storytelling and consistent messaging that builds emotional connection and brand recognition over time.

5. Differentiate and Strengthen Your Brand

In a sea of lookalike plans, brand trust wins.

• Refresh your creative and positioning to highlight your commitment to member-focused care, cultural relevance and accessibility.
• Highlight your community roots, culturally relevant care, food and transportation benefits and member testimonials.
• Use earned media and grassroots outreach to amplify your mission and impact.

The Opportunity Ahead

The next chapter of Medicaid will belong to the plans that evolve the fastest. Success will go to those that modernize their marketing, strengthen retention efforts and clearly communicate their value. Standing out in a crowded and competitive marketplace requires speed, clarity and member-first strategies.