Big step forward for Ohio Medicaid, but more to come

On April 9, Ohio Department of Medicaid Director Maureen Corcoran made a long-awaited announcement; revealing the names of the Medicaid managed-care insurance companies that would get to share in a 20 billion dollar, five-year contract (the State of Ohio’s largest contract ever) to provide health care services for 3 million Ohioans.

Director Corcoran said repeatedly that she wanted to “focus on people and not just the business of managed care.”

The announcement had been delayed; likely because of a lawsuit that Ohio Attorney General David Yost had filed against Centene (the parent company of Buckeye Community Health Plan) accusing the company of “a conspiracy to wrongfully and unlawfully obtain … tens of millions of dollars” in Medicaid payments. It’s not clear how this situation will resolve itself, but it seems likely that Centene has a strong incentive to settle this case.

The announcement of the winning plans was the culmination of a process that began a little more than two years ago. In fact, Governor Mike DeWine signaled early that he wanted to re-procure Ohio’s Medicaid managed-care contracts. Director Corcoran said repeatedly that she wanted to “focus on people and not just the business of managed care.”

The Ohio Department of Medicaid then engaged in a robust public engagement process to evaluate the current system and to hear what a better system might include. Officials spoke directly with Ohio Medicaid members and their families at 17 listening sessions held throughout Ohio. Another 50 meetings were held with health care providers, provider associations, advocates and other stakeholders. Taken together, this feedback provided the department with more than 1,000 comments. The department then made all the information public, and when the managed care request for proposals was released you could see many of the public comments reflected in the document.

Eleven insurance plans ultimately responded to Ohio’s Medicaid managed care request for proposals. According to the Ohio Department of Medicaid, applications were scored on a regional basis and may have received multiple scores based upon regional differences. Applicants could score a maximum of 1,110 points. The department determined that any applicant that received a score of 606 or lower was not selected. These lower scoring applicants included Aetna Better Health of Ohio, Medical Mutual of Ohio, Ohio Employee Health Partnership, and Paramount Advantage. Paramount Advantage was the only one of Medicaid’s existing plans not to be re-selected. Approximately 273,000 people are currently enrolled in the Paramount Advantage plan. The top-scoring plan was UnitedHealthcare Community Plan of Ohio, Inc. (905) while the lowest scoring plan was CareSoure Ohio, Inc. (687.5 & 680). Plans new to the Ohio Medicaid managed care market included AmeriHealth Caritas Ohio, Inc. and Anthem Blue Cross and Blue Shield.


Insurance Companies That Responded to Ohio Medicaid Request for Proposals

ScorePlanProposed Award
905 UnitedHealthcare Community Plan of Ohio, Inc.1
752.5Humana Health Plan of Ohio, Inc.2
717.5Molina Healthcare of Ohio, Inc.3
696.25AmeriHealth Caritas Ohio, Inc.4
693.65 & 686.25 Anthem Blue Cross and Blue Shield5
687.5 & 680CareSource Ohio, Inc.6
Buckeye Community Health PlanDefer

Any final decision related to Buckeye Community Health Plan is subject to additional consideration by Medicaid under sections 5.13 and 5.14 of the RFA, based on the claims by the Ohio Attorney General, Medicaid, and the State of Ohio in litigation recently filed in the Franklin County Court of Common Pleas and other factors. At this time, Medicaid is neither issuing nor denying an award to Buckeye Community Health Plan.

What to expect next?

Ready, Set, Go: Now that the decision has been made, expect the department to turn its attention to ensuring new plans are ready to start serving members and pay claims by the go-live date of January 2, 2022.

Buckeye Woes: I am not referring to the OSU basketball team, but rather to the litigation risk that Buckeye Community Health Plan is facing. Depending on how long it drags on, it could end up eliminating the health plan from the list of participants. There are currently 428,000 people enrolled in the Buckeye Community Health Plan.

No One Loses Coverage: Medicaid members will continue to receive services through their current managed care plans until the transition in early 2022 and no one should lose coverage because of the change in health plans.

Bring on the Lawyers: Losing insurers have until April 23 to challenge the state’s decision and file a protest. After that it’s likely that one or more firms will file lawsuits challenging the decision. Every state that goes through a procurement process of this magnitude experiences some level of legal action afterwards.

So Many Choices: Medicaid members should be able to select a new plan during the 2021 open enrollment period later this summer and may have as many as seven plans to choose from. If members do not select a plan, one will be automatically assigned to them. Expect a battle over how the decision is made to distribute members who don’t choose a plan. If neither Paramount or Buckeye end up on the final list as many as 665,000 members will have to choose a new plan.

Steady as They Go: The department is likely to shy away from adopting policy shifts while the readiness effort is underway. Ohio Medicaid doesn’t want to do anything that would upset actuarial projections because Medicaid staff will largely be focused on preparing for the big shift to the new plans and approach.

Mischief Makers: Winning or losing Medicaid managed care plans may try to better position themselves by adding amendments to the state budget. Expect Governor Mike DeWine to have his “veto” pen ready.

Keep an Eye on Washington: One big source of disruption will be the eventual ending of the COVID-19 federal public health emergency. Once that ends, the Department of Job and Families Services and its county partners will begin processing Medicaid paperwork that was temporarily ceased. Expect tens of thousands to lose their Medicaid coverage, some of whom are probably no longer eligible because their incomes have risen.

Making New Friends: Providers have at least two new health plans they will have to get to know; but don’t be surprised if there is a bit of a personnel shuffle between plans as the year goes forward.

Expect the Unexpected: It ain’t over till It’s over. But remember, a lot can (and will) change between now and next January so visit often for the most current updates and analysis.