The state of Iowa announced two companies are bidding for a spot on Iowa’s Medicaid managed-care program, one of which is one of the largest health care insurers in the country.

The Department of Human Services on Monday disclosed the identities of Iowa Total Care and Trusted Health Plan as bidders to help run the state’s $5 billion Medicaid program.

The Department of Human Services estimates the notice of intent to award “will be published on or around May 1,” the state said Monday.

The company selected would become the state’s third managed-care organization and would start administering coverage to members July 1, 2019.

Trusted Health Plan is headquartered in Washington, D.C.

Iowa Total Care is a subsidiary of Centene, a St. Louis, Mo.-based carrier bid to be a part of the state’s Medicaid program in 2015 before managed care launched the following April. It was not among the four companies selected.

Centene currently works with Medicaid programs in 21 states, according to its website.

The only remaining organizations administering coverage to members today are Amerigroup of Iowa and UnitedHealthcare of the River Valley.

According to Kaiser Health News, Centene was among the insurance companies who made profits off the Medicaid program in California, bringing in a total of $1.1 billion in profit from 2014 to 2016 in that state.

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Medica Health Plans had inquired about bidding earlier this year, it eventually announced it would not.

The state previously had three managed-care organizations when Iowa rolled out Medicaid managed care in April 2016. However, state officials posted a request-for-proposal in October 2017, after one of the insurers — AmeriHealth Caritas — announced it would leave the state at the end of November,

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