MM Curator summary
MCO bidders in Ohio are getting anxious.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
State leaders haven’t yet announced which insurance companies — among them CareSource — will be chosen to be a part of Ohio Medicaid’s overhaul.
Bids were due Nov. 20 and Ohio Medicaid’s original goal was to let the winning bidders know with award letters Jan. 25. It’s not clear when the awards will be announced.
The goal is for the newly rebid system to go live Jan. 5, 2022.
The decision could alter the future of Dayton-based CareSource, which is one of the city’s largest employers and also is the state’s current largest contractor managing Medicaid plans.
Insurance companies that manage Medicaid plans are tasked with deciding which providers are in-network for those Medicaid members, paying medical claims, and coordinating care.
As of November, about 1.3 million Ohioans had their Medicaid plan through CareSource, making it the largest Medicaid managed care plan in the state and larger than the other four insurance plans combined.
CareSource has nearly 2 million members in Georgia, Indiana, Kentucky, Ohio and West Virginia, primarily through state Medicaid programs, though the company also sells individual, Medicare Advantage, and dual-eligible Medicaid and Medicare plans.
Nearly half of Ohio children, half of Ohio births and the majority of nursing home care is covered by Medicaid. Because of this broad reach, a wide range of policy goals such as better outcomes for opioid addiction, better birth outcomes, or a more efficient use of taxpayer money can be engineered by what kind of requirements a state puts in place for how Medicaid money gets spent.
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.