[MM Curator Summary]: All of the OH Medicaid reforms except OH Rise are on hold while the state deals with the PHE wind-down efforts.
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.
The projected launch date of Ohio’s revamped and reformed Medicaid managed care system will still be July – except this month, given a potential crisis where many may be kicked off Medicaid, the state pushed back most of the reforms to the end of this year.
“It seems like this new phased approach still allows them to move forward with everything, but in a way that is manageable…to maybe take smaller bites of the apple,” said Loren Anthes, who chairs Community Solutions’ Center for Medicaid Policy.
Medicaid, government-paid health insurance for more than 3 million low-income or disabled Ohioans, is typically the state’s largest expenditure totaling billions of dollars. The “next generation” system is the result of an extensive process that started in 2019, looking at ways to overhaul the system after years of issues and lack of reform.
According to the Ohio Department of Medicaid, one of those reforms will still be up and running in July. OhioRISE is a new coverage system to treat children with severe behavioral and mental problems so parents don’t have to give up custody.
But all the other more complicated changes, such as a single pharmacy benefit manager to prevent prescription drug “middlemen” from overcharging taxpayers, won’t happen until October at the earliest. The same applies to the two to three new health plan options entering the system: AmeriHealth Caritas, Humana, and Anthem Blue Cross and Blue Shield.
Why the delay?
The planned July launch date could coincide with the end of the federal government’s COVID-19 emergency declaration, which prevented states from kicking ineligible people off Medicaid. When that ends, almost everybody will have to go through eligibility checks – a daunting task for an understaffed system that could also leave Ohioans confused over if they still have health insurance.
Spreading the Medicaid reforms out to later in the year would prevent a disaster scenario where both the eligibility checks and the new reforms go awry at the same time, said Anthes, the Medicaid policy expert.
“It is important that the reforms and improvements embodied in the Next Generation program are not compromised with a hurried launch, or potentially confusing communications,” the Medicaid department said in a document sent to lawmakers.
Despite the later timeline, Medicaid participants still can choose to enroll into one of the new plan options now, said department spokesperson Lisa Lawless. They’ll just remain on their current health plan until the end of the year when the switch occurs.
Starting dates for the new system were pushed back before, and some lawmakers have been concerned with how long implementation has taken. But the department insists they are not rushed.
“Doing this correctly is more important than meeting an administratively imposed timeline,” it told lawmakers.