Medicaid managed care plans should consider merging in order to best prepare for the future, a new report from PricewaterhouseCoopers advises.

The report, released Thursday, warns that Medicaid’s “explosive” growth of 15 million new beneficiaries over the past two years will slow over the coming years, signaling that “the era of easy Medicaid growth is over.” One in four Americans are currently enrolled in Medicaid.

Enrollment in private managed care plans has progressed past 70% of the total Medicaid population and will soon reach a ceiling before the only un-enrolled populations left are located in rural, difficult to manage areas, report authors predict.

To position themselves for a successful future, the report advises managed plans to consolidate, which can help “advance financial objectives.” The report’s authors note that consolidation has been made easier thanks to recent proposed regulations on managed care, which may help bridge the gap in local differences in operating structure.

Click here to read the full PricewaterhouseCoopers report, “The Still Expanding State of Medicaid in the United States.”