Medicaid/Medicare

Ohio Senate pushes for another re-bid of Medicaid managed care contracts

After a more-than-two-year effort to overhaul Ohio's Medicaid managed care system, state senators are asking for what could amount to a redo of the whole thing (Source: “Ohio announced huge contracts for companies to handle Medicaid managed care. Lawmakers want a redo,” Columbus Dispatch, June 3).

The state in April had chosen six companies to handle Medicaid for most Ohio enrollees. But at least two of the companies who lost out on contracts filed complaints against the Ohio Department of Medicaid.

Those complaints have turned into legislative action.

Senate Republicans on Tuesday inserted language into the state budget bill requiring the state to complete a new procurement process, with the stipulation that new contracts with Medicaid managed care organizations must include those based in Ohio.


HPIO releases Ohio Medicaid Basics 2021

Earlier this week, the Health Policy Institute of Ohio released Ohio Medicaid Basics 2021.

Medicaid pays for healthcare services for more than three million Ohioans with low incomes, including almost 1.3 million children. Federal and state expenditures on Medicaid accounted for about 38% of Ohio’s budget in state fiscal year 2020. And $1 out of every $6 spent on health care in the U.S. is spent on Medicaid.

As the payor of healthcare services for more than a quarter of all Ohioans, Medicaid can be leveraged to make large-scale policy changes that impact the health of residents. 

Released to coincide with the state biennial budget, Ohio Medicaid Basics provides a foundational summary of the state-federal program. The 2021 edition provides an overview of Ohio Medicaid eligibility, enrollment and financing. The brief also includes an update of significant changes to Ohio Medicaid in the past year.

HPIO has created Medicaid Basics every two years since 2005.


ODM hires PBM watchdog

The Ohio Department of Medicaid completed its revamp of the pharmacy benefit manager program Wednesday by awarding a contract to a company that will serve as a watchdog (Source: “As part of revamp, Ohio Medicaid hires watchdog for state-run pharmacy benefits manager,” Columbus Dispatch, April 14).

Indianapolis firm Myers and Stauffer will be paid an average of $1.5 million a year under a two-year pact that has an additional six optional years. The price tag if the deal remains in place for the entire eight years would be $12 million.

The new firm — which already manages the National Average Drug Acquisition Cost database for the federal government — essentially will act as a watchdog on a state-run PBM.

The restructuring is expected to take effect in early January. It replaces a setup that has Medicaid-hired managed-care organizations hire the pharmacy benefit managers, which act as middlemen in the drug supply chain.


State announces new Medicaid managed care contracts

The DeWine administration announced the winners of contracts to lead sweeping changes in the $20 billion Medicaid managed care system (Source: “Six companies will split $20B in managed-care work under biggest contract in Ohio history,” Columbus Dispatch, April 9).

In what was labeled as likely the largest pact in Ohio state government history, six companies are being hired to coordinate the federal-state health insurance for more than 3 million low-income or disabled Ohioans.

"What is really the revolutionary component here is that we have looked at all of the most cutting-edge practices, and we are pushing our system to the next generation," said Ohio Medicaid Director Maureen Corcoran.

"The entire country is watching us because there are some really important things we are doing differently."


Many pregnant women with low incomes lose insurance coverage after giving birth, study finds

While many pregnant women gain coverage through Medicaid, ensuring they have insurance after giving birth remains a significant challenge, according to a new study (Source: “Study: 1 in 3 women with prenatal Medicaid lack coverage before or after pregnancy,” Fierce Healthcare, April 7).

An Urban Institute study found that 26.8% of new mothers covered for prenatal care through Medicaid were uninsured prior to becoming pregnant. In addition, 21.9% became uninsured again within two to six months of their child's birth, the study found.

The study found higher rates of women without coverage in states that did not expand Medicaid and among Hispanic women. The researchers said that the difference in insurance rates between new Black and White mothers was smaller and that boosting coverage wouldn't necessarily tackle high rates of maternal mortality among Black women.


Biden administration expected to rescind approval for state Medicaid work requirements

The Biden administration is planning today to wipe out one of the core health policies of the Trump era, taking actions that will immediately rescind permission for states to compel poor residents to work in exchange for receiving Medicaid benefits (Source: “Biden administration to move Friday to rescind Medicaid work requirements,” Washington Post, Feb. 11).

Federal health officials will withdraw their predecessors’ invitation to states to apply for approval to impose such work requirements. They also will notify 10 states granted permission, including Ohio, that it is about to be retracted, according to a draft plan obtained by The Washington Post and confirmed by two individuals familiar with the decision, who spoke on the condition of anonymity because they were not authorized to discuss the matter publicly.

The actions anticipated Friday, outlined in bullet points in the draft, will come two weeks after President Biden signed an executive order instructing officials to remove barriers to Medicaid coverage. Work requirements enabled under President Donald Trump were the one policy mentioned in Biden’s directive.


SCOTUS agrees to hear case on Medicaid work requirements

The U.S. Supreme Court has agreed to hear a case on the Trump administration’s push for Medicaid work requirements, though the issue could be moot when President-elect Joe Biden takes office (Source: “Supreme Court to hear case on Trump's push for Medicaid work requirements,” The Hill, Dec. 5).

The Trump administration earlier this year had appealed lower court rulings that found the requirements adopted by New Hampshire and Arkansas to be unlawful. More than 18,000 people lost coverage in Arkansas due to work requirements before they were halted by a lower court.

Medicaid work requirements have been a priority for the Trump administration, though the incoming Biden administration is expected to eliminate the rules while pushing to expand access to Medicaid.


States consider options for end to extra federal Medicaid payments

 

State officials are asking the federal government for more information to help them prepare for an eventual end to increased federal funding from the first COVID-19 relief law this year (Source: “States grapple with plans for end to coronavirus public health emergency,” Roll Call, Dec. 3). 

The health emergency is set to expire Jan. 20 but will almost certainly be extended by the next administration. The question is how states will transition to normal operations.

“The issue and the challenge is that CMS, I am sure, doesn’t want to send states a signal that the public health emergency is ending, given where we are. But on the other hand, states feel like they need some indications of what to do and when to do it,” said Allison Orris, counsel with Manatt Health and a former federal health policy official.

A CMS spokesperson pointed to existing guidance to states saying that the enhanced federal funding for Medicaid — a 6.2 percentage point increase being added to states' Federal Medical Assistance Percentage rates — will stop at the end of the quarter when the public health emergency ends. The spokesperson said it’s too early to speculate on potential status changes for the health emergency, and CMS remains in constant contact with states.


Deadline for Ohio Medicaid managed care bids is today

 

Bids are due today for insurance companies that want to be a part of Ohio Medicaid’s overhaul  (Source: “Insurance company bids due today for Ohio Medicaid overhaul,” Dayton Daily News, Nov. 20).

The state is overhauling how the health insurance program for people who are disabled or have low incomes operates and picking new insurance companies as contractors to manage those insurance claims. By rebidding the contracts, the state can update the conditions for getting and spending Medicaid dollars and can re-select which insurers it trusts to meet its goals.

In 2019, Ohio paid about $17 billion to Medicaid HMOs and about 90% of the 3 million Ohioans who are covered by Medicaid get an insurance plan managed by an insurance company. These insurers get a payment per member per month and use that money to pay for their member’s health care.


Ohio Medicaid facing budget gap

As Medicaid enrollment increases amid the pandemic and recession, declining state revenue and a projected budget shortfall will challenge the $23 billion budget of the federal-state program, Medicaid Director Maureen Corcoran said during a virtual post-election conference (Source: “Ohio Medicaid caseload soars due to COVID-19, but now program faces budget gap of billions,” The Columbus Dispatch, Nov. 6).

Medicaid caseloads have surged during the coronavirus pandemic, topping 3 million this year, up 9%, from last year.

During a discussion on health care and Medicaid during Impact Ohio's post-election conference, Corcoran and representatives of the healthcare industry said the coronavirus has strained the system, but also spurred improvements, such as expanded telehealth services.