Category: Medicaid

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...

February 20, 2018

94% of Providers Submitting Claims Have Had at Least One Payment, Nearly 1 in 3 Have Yet to Submit

It has now been more than six weeks since the Ohio Department of Medicaid (ODM) and the Department of Mental Health and Addiction Services (ODMHAS) launched Behavioral Health Redesign on a fee-for-service basis and via the MyCare Ohio plans. In that time, 433 unique providers have submitted claims to ODM for newly available and recoded...

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...

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...

June 29, 2017

JMOC Hears Testimony from ODM, ODMHAS, and Behavioral Health Providers as Redesign Implementation is Delayed

After over two years of preparing to carve new behavioral health benefits into Medicaid managed care plans and recode all Medicaid behavioral health services to align with national coding standards, the Ohio Departments of Medicaid (ODM) and Mental Health and Addiction Services (ODMHAS) had announced they were ready to go live with the Behavioral Health...