Category: Medicaid

August 16, 2018

Ohio Medicaid ends “spread” pricing for prescription drugs, discussion around contractual Medicaid overhead costs just beginning

By: Loren Anthes, Public Policy Fellow, Medicaid Policy Center Adam White, Policy and Planning Assistant   Background The Ohio Department of Medicaid (ODM) announced on Tuesday, August 14 that it is directing Medicaid Managed Care Organizations (MCOs) to cancel contracts with Pharmacy Benefit Managers (PBMs) that use a “spread pricing” model. Spread pricing allows PBMs to keep...

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...

July 2, 2018

Administration, Managed Care Plans Signal They’re Ready for Final Phase of Behavioral Health Redesign, June JMOC Pt. 1

This is the first of a two-part blog covering the June 28, 2018 meeting of the Joint Medicaid Oversight Committee. The second part addresses the committee’s discussion on pharmacy benefit managers (PBMs), and can be found here. On July 1, behavioral health providers began submitting claims for services to Ohio’s five Medicaid managed care plans...

April 30, 2018

Hungry for Policy: A Deeper Dive on Older Adults

The Center for Community Solutions Public Policy Fellow Loren Anthes recently authored an issue brief on the relationship between food insecurity and Medicaid. One of the key takeaways from the brief is that “as a social determinant of health, food insecurity increases cost and diminishes outcomes in health care.” With a high number of older...

April 23, 2018

Medicaid Work Requirement Waiver to be Submitted to Federal Government by End of April, ODM Director Informs JMOC

At the April meeting of the Joint Medicaid Oversight Committee (JMOC), the Director of the Ohio Department of Medicaid (ODM), Barbara Sears, notified committee members that her department intends to submit Ohio’s request for federal waiver authority to implement work requirements for the Medicaid expansion population by the end of this month. The Center for...

April 9, 2018

IMD waivers and the opiate epidemic: Ohio, other states and money

By: Loren Anthes, Adam White  The opiate crisis in Ohio has precipitated many policy conversations about how to curb opiate-based mortality, provide better treatment and encourage recovery. Providers, lawmakers and The Center for Community Solutions have all looked at the ways in which Medicaid policy could be leveraged to address this need. As we have...

April 5, 2018

Ohio Medicaid Funding for County Program for Children with Autism, and Other Mental Health Needs, Slated to End

In less than 100 days the Ohio Department of Medicaid (ODM) is poised to end a special funding arrangement for a 27-year-old program in Cuyahoga County called Positive Education Program (PEP) Connections. Each year, PEP Connections serves nearly 900 high-risk youth with autism, and or other intensive mental health needs who are also at risk...

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...