Author: Loren Anthes

Home / Loren Anthes
August 21, 2018

Analysis of Ohio’s report on Medicaid expansion

On Tuesday, August 21, the Ohio Department of Medicaid (ODM) released the second “assessment” of the Medicaid expansion as a follow-up to the first, General Assembly required, assessment from 2016. In this document the ODM found the following: EMPLOYMENT Employment for enrollees went up 15%, meaning 1 in 2 expansion enrollees are working The most...

July 30, 2018

If You Want to Cut Costs in Medicaid, Sharpen Your Knives: Innovation in Medicaid Pharmacy

Pharmacy is a Byzantine policy area that confounds and frustrates wonks, reporters and policymakers alike. However, it is common knowledge that the pharmacy benefit in Medicaid is, if anything, a major driver of cost. While this is well known and was most recently identified by the Joint Medicaid Oversight Committee’s (JMOC) actuary in late 2016,...

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...