MM Curator summary
Ohio managed care and PBM changes will begin 6 months later than originally planned.
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Ohio pushed back its projected launch date of its revamped and reformed Medicaid managed care system to July 1 of next year, the Ohio Department of Medicaid announced Wednesday.
The initial timeline set the launch of the long-awaited system in January.
“Our priority since the beginning of this administration has been on doing this right for the people we serve,” said Ohio Medicaid Director Maureen Corcoran. “A July 2022 go-live gives us time to support and inform our members about the new program, to work with community leaders and respond to the feedback received from the plans and providers.”
The “next generation” managed care system is the result of an extensive process that started in 2019, looking at ways to improve and overhaul the system after years of issues and without any reform.
Medicaid, the governmental health insurance for more than 3 million low-income or disabled Ohioans, is typically the state’s largest expenditure, with billions of dollars at stake.
The department already has many of the reforms planned and designed out; it’s just a matter of feedback and implementation. Of note are the additions of OhioRISE, which would treat children with severe behavioral and mental problems so parents don’t have to give up custody, and a single pharmacy benefit manager system, to fix the issue of such prescription drug “middlemen” overcharging taxpayers.
The delay in rolling out these reforms is partly due to the unanticipated “persistence of COVID-19 and its impact on individuals served by the program and their providers,” said the Medicaid department.
There’s uncertainty on when the end of the federal public health emergency declaration for COVID-19 will be. The declaration’s end will impact the department’s plans in terms of whether there will be additional federal money, said Corcoran in a media briefing. Medicaid officials were also worried how the transition could cause instability for consumers amid a pandemic.
Other factors will complicate the situation. As part of the overhaul, the department re-selected which health plans got its lucrative contracts to handle Medicaid managed care, and those who lost out have complained.
Buckeye Community Health Plan and its parent company Centene were initially deferred due to an ongoing lawsuit from the state alleging the company unlawfully took Medicaid money. But that has since been settled, and Centene was recently granted a contract.
Paramount Advantage, owned by Toledo-based ProMedica, is the only current Medicaid managed care organization that lost out on a contract. It tried to reverse that by appealing the decision and asking state lawmakers for help, but those efforts failed.
The Toledo company now has a lawsuit in the state seeking to halt the overhaul and invalidate the contracts. If successful, that could further derail the department’s timeline.
According to court records, a trial assignment was scheduled for July 25, 2022. A hearing for a preliminary injunction is set for earlier, on Oct. 12.
Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.