Author: Loren Anthes

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July 16, 2018

Managed Care Organizations and Medicaid Performance

I recently authored an Issue Brief on the role data plays in Ohio’s Medicaid program. In developing that piece, I tried to approach data as a tool in business infrastructure development for the government “as an insurance organization,” which, for all intents and purposes, is what Medicaid is. If the mission of this insurance organization...

March 16, 2018

March Joint Medicaid Oversight Committee focuses on CVS, Caremark Business Practices

While the agenda of the March 15th Joint Medicaid Oversight Committee (JMOC) did include the regular review of the Behavioral Health Redesign, the majority of the conversation centered on Medicaid Managed Care Organizations (MCOs) and Ohio’s pharmacy benefit. As has been reported by multiple outlets, CVS and Caremark, CVS’ Pharmacy Benefit Manager (PBM), have faced...

March 12, 2018

Public Comments to the Ohio Department of Medicaid on the Proposed Medicaid Work Requirement Waiver

Loren Anthes, Public Policy Fellow, Medicaid Policy Center INTRODUCTION Pursuant to Ohio Revised Code §5166.37, [1] the Ohio General Assembly has mandated the Ohio Department of Medicaid seek federal approval for an 1115 Demonstration Waiver imposing work requirements on individuals covered through Medicaid via the Group VIII expansion. Pursuant to law established in the Patient Protection...

February 21, 2018

Work Requirement Waiver

BACKGROUND On February 16th, the Ohio Department of Medicaid, pursuant to Ohio Revised Code section 5166.37 established in the biennial budget of 2017, posted its proposal to implement work requirements for the Medicaid expansion population. The Department is seeking the change in policy through the vehicle of an 1115 demonstration waiver. It will serve as...

November 16, 2017

Joint Medicaid Oversight Committee: Behavioral Health Redesign Beta Testing Part II

On November 16, the Joint Medicaid Oversight Committee (JMOC) met to revisit the topic of beta testing Ohio’s Behavioral Health Redesign. This time, in addition to a presentation by Medicaid Director Barbara Sears and other Kasich administration staff, JMOC heard from the Ohio Association of Health Plans (OAHP), The Ohio Council of Behavioral Health &...

November 7, 2017

The New Rules of Waivers and State Plan Amendments

On Tuesday November 7th, the federal Department of Health and Human Services outlined its new criteria for reviewing states’ efforts to experiment with their Medicaid programs. In a press release sent out by the Centers for Medicare and Medicaid Services (CMS), Director Seema Verma outlined her “vision” for the Medicaid program, which includes a new...

October 23, 2017

Joint Medicaid Oversight Committee: Behavioral Health Redesign Beta Testing

On October 19, the Joint Medicaid Oversight Committee (JMOC) met to continue the conversation regarding the progress of Ohio’s Behavioral Health Redesign. In the presentation offered by the state before next week’s commencement of beta testing for claims, the state outlined metrics they have will be using to document their progress including number of patients...

September 27, 2017

Joint Medicaid Oversight Committee: Medicaid Budgeting and the Behavioral Health Redesign

On September 21, the Joint Medicaid Oversight Committee (JMOC) met to discuss the state budget process and the Behavioral Health Redesign and, on September 22, the state convened one of its regional forums on the redesign for providers. These two events can demonstrate how policy is discussed in the context of committee and the practical...

August 23, 2017

Senate Veto Overrides: Senate Veto Overrides: Implications for Ohio’s Medicaid Program

On Tuesday, August 22, the Senate voted to override six of Governor Kasich’s Medicaid-related vetoes. In July, the House had overridden 11 of the governor’s vetoes, 10 of which dealt with Medicaid, meaning that the Senate can still act on four of those Medicaid-related provisions pushed forward by the House. Several of the veto overrides...

April 26, 2017

State Budget Update: Medicaid Changes in House Substitute Bill

With the budget in full swing, the Ohio House has offered its first amendments to the governor’s proposed budget. This action is the first in a multi-step process that will soon include another round of consolidated amendments (Omnibus) before it is voted on by the full House and sent to the Senate. Even though we...