The January meeting of the Joint Medicaid Oversight Committee (JMOC) covered the latest information on the behavioral health redesign, and a big picture look at Medicaid spending from JMOC’s actuary, Optumas.

Key Takeaways

• Through January 16, about 20,000 claims had been submitted, with a denial rate of 23 percent
• ODM expect this denial rate to decline
• Optumas pointed to items like growing older population and increasing pharmacy costs that are key cost factors and need further inspection
• Optumas suggested looking at the rising costs from two perspectives: controllable and uncontrollable, and to focus on the controllable items where policy change can make an impact

Medicaid Director Barbara Sears provided a look at how claims for behavioral health services are processed through the system. Through January 16, around 20,000 claims had been submitted, with a denial rate of 23 percent. Ohio Department of Medicaid (ODM) expects this rate to decline as the system matures. At the last JMOC meeting, ODM shared that they had developed an advance payment agreement option for providers who were not ready to move forward with redesign at the beginning of the year. ODM will begin collecting the advance payments over the course of the next several months. So far, 45 individual entities have entered into advance payment agreements according to ODM. JMOC asked that ODM continue to report back on how implementation is progressing, and identify any major issues and the solutions along the way.

Optumas, shared a presentation that took a look at the big picture issues in Medicaid. It began by reiterating the goal of reducing the rate of growth in Medicaid, while increasing quality. Optumas pointed out several items that are key factors in Medicaid costs that should be examined:

• The 55-64 age group is growing at a faster rate than others, and the state needs to identify some short and long-term interventions to address             medical costs associated with this population.
• The highest proportion of spending is in two categories: hospitals and nursing facilities.
• Fragmented behavioral health and primary care services drive inpatient costs.
• Pharmacy costs continue to increase.

In response to a question from Senator Dave Burke, Optumas shared that Ohio’s rate of growth in Medicaid spending does not exceed the national average. Optumas representatives also said to specifically compare it to another state would take some time, since Ohio has so many moving Medicaid parts right now.

Optumas offered two pieces of information on how to bend the cost curve. First, it is important to implement current initiatives like behavioral health redesign and MyCare, successfully. Second, Optumas suggested looking at the rate of growth from two perspectives: controllable and uncontrollable, and to focus on the controllable items where policy change can make an impact.

In response to Senator Bill Coley’s question about Medicaid waivers, and his statement estimating that Medicaid waivers may have more of an impact on enrollment than on spending, Optumas shared that it does not have specific information about Ohio’s waivers, but that it will work with ODM to provide what the potential impact may look like in the future.

JMOC will reconvene on February 15, 2018.