The nurse documents her patient's concerns at her first house call.

Humana’s announcement last week to acquire Wisconsin managed care organization Inclusa moves the company deeper into the lucrative long-term care services and supports market for Medicaid beneficiaries, as well as beneficiaries dually eligible for Medicare and Medicaid. 

The Inclusa deal will add approximately 16,000 clients to the 1 million Medicaid beneficiaries Humana is already serving in seven states. Inclusa works with more than 6,000 providers in approximately 40 service categories and is under contract with Wisconsin to provide family care services in most of the state’s 72 counties. Inclusa is Humana’s second acquisition in Wisconsin, following the purchase of healthcare firm iCare in 2020. 

“The long-term care services delivered by Inclusa and their contracted providers under Wisconsin’s Family Care program provide important assistance for eligible individuals that value their member-centered care model,” Humana Medicaid President John Barger said in a statement. “We look forward to combining Inclusa’s and Humana’s expertise and capabilities to grow the Inclusa business and help even more people get the long-term care they need.” 

Medicaid has become an increasingly attractive business for payers as increased federal funds during the COVID-19 pandemic encouraged states to expand their Medicaid programs. A temporary 10% increase in the Federal Medical Assistance Percentage (FMAP) will provide an additional $12.7 billion for states through March 2024.  A recent report by the Kaiser Family Foundation estimated that Medicaid enrollment will grow 25% by the end of this year. 

About 12 million Americans are dually eligible for Medicare and Medicaid benefits, according to the Alliance for Health Policy. However, only about 1 in 10 are receiving benefits. Allison Rizer, ATI Advisory’s principal and business lead for Medicare-Medicaid integration and long term support services, told McKnight’s Home Care Daily Pulse these patients tend to have complex medical and social needs. She said that is part of the reason they are garnering so much attention from payers and policymakers alike.

“A growing number of states now require Medicaid health plans serving dual-eligible individuals to bear Medicare risk, and vice-versa,” Rizer said. “At ATI Advisory, many of our payer and at-risk provider clients are investing heavily on innovation as policymakers push for change.”

Humana did not offer guidance on when it hopes to close the Inclusa deal. Last week the company announced it divested a majority interest of Kindred at Home, its hospice and personal care unit, to private investment firm Clayton, Dubilier & Rice. Humana is an integrated provider of healthcare services, including insurance and clinical services.