CareFirst Names New CEO With Medicaid Focus to Lead Regional Insurer

Kurt C. Small, the executive who spent nearly seven years overseeing an 8.5 million-member Medicaid business at Elevance Health, was named president and CEO of CareFirst BlueCross BlueShield on March 31, stepping into Baltimore's largest private health insurer at a moment when premium hikes and rising medical costs are squeezing members, employers and providers across the region.

Small takes the helm May 4. He inherits a company that the Maryland Insurance Administration approved to raise individual market premiums by 13.1% to 13.6% for 2026, well below CareFirst's initial ask of up to 18.7% but still far outpacing the state's projection that overall healthcare costs will climb 6.5% this year, including a 10.4% spike in pharmaceutical spending and a 4.8% rise in hospital services.

Before his nearly seven years at Elevance, Small held executive roles at Blue Cross and Blue Shield of Minnesota and Highmark, and spent more than a decade at Aetna, giving him a track record across commercial, federal, and Medicaid lines of business. CareFirst Board Chair Jeff DiLisi pointed to that breadth when announcing the hire. "Kurt brings leadership, vision and deep regional understanding that will further strengthen CareFirst's mission-driven approach," DiLisi said, adding that Small's "operational expertise and commitment to better health will help CareFirst build on its momentum strengthening affordability, expanding access to care and delivering even greater impact for the people and communities we serve."

Small replaces Brian D. Pieninck, who led CareFirst from 2018 until stepping down in September 2025 to become CEO of GuideWell Mutual Holding Corporation, the Florida-based parent of Florida Blue. Chief Financial Officer Ja'Ron Bridges served as interim president and CEO through the national search and will return to his CFO duties once the transition is complete.

The choice of a Medicaid specialist carries direct consequences for Baltimore's safety-net providers and community health programs. CareFirst's 3.5 million members span Maryland, Washington, D.C., and Northern Virginia, and the company's Medicaid managed care contracts reach hospitals, federally qualified health centers, and behavioral health providers throughout the city. Maryland hospitals and Medicaid advocates will be watching Small's early decisions on provider reimbursement rates, prior authorization policy, and how CareFirst directs its philanthropic investments toward community health.

Post-pandemic pressures compound those priorities: growing prescription costs, tighter federal Medicaid funding, and the ongoing membership churn from Medicaid redeterminations that displaced hundreds of thousands of Marylanders after the public health emergency wound down. Small built his career managing scale in exactly that environment.