The Director of the Ohio Department of Medicaid (ODM) Maureen Corcoran appeared before the Joint Medicaid Oversight Committee (JMOC) for the first time in her tenure on Thursday. Since this was the first JMOC meeting of the 133rd General Assembly, there was a lot of content to cover, followed by a lot of questions over the two-hour hearing. Corcoran offered thorough testimony on the basics of Medicaid, the nuances of Ohio’s Medicaid program and highlighted state budget priority areas that fall within the purview of the department. Key topics legislators brought up included: the structure of supplying pharmaceuticals to Medicaid beneficiaries and the role of pharmacy benefit managers (PBM), declining caseloads in the Medicaid expansion and Covered Families and Children eligibility categories, the re-procurement of Medicaid managed care contracts, the backlog in the Ohio Benefits system and funding changes to accommodate a Medicaid expansion population with higher than expected morbidity.
Declines in Medicaid caseload were compared to trends in caseloads for the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families program
Declining caseloads and the backlog of pending cases in Ohio Benefits have been well-documented in the news and reports over the last several weeks, including reports by The Center for Community Solutions. Director Corcoran shed additional light on the factors that have contributed to the caseload decline such as economic factors like a strong overall economy and high income sensitivity of the Medicaid expansion population and families and children covered by Medicaid. Declines in Medicaid caseload were compared to trends in caseloads for the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) program. Caseloads in SNAP and TANF had declined prior to declines in Medicaid enrollment, primarily due to policy decisions made around eligibility and work requirements and less so due to overall economic conditions. Eligibility for Medicaid, SNAP and TANF in Ohio runs through the Ohio Benefits system, which first went online with Medicaid and then added in SNAP and TANF about 18 months ago. Other factors that have contributed to the Medicaid caseload changes are the relationship between parent and child coverage (a parent could lose eligibility and not realize that their child could still be eligible), the loss of federal funding for insurance/benefits navigators and delayed renewals during the development of the Ohio Benefits system.
As it relates to the backlog in cases in Ohio Benefits, Medicaid is developing a corrective action plan to address the issues that have been percolating since 2015. That plan will be submitted to the Centers for Medicare and Medicaid Services (CMS). Corcoran assured the committee that the department is dedicating significant resources to address the many contributing factors. Despite this, complete correction of the issues that resulted in the backlog is not expected for three to four years.
The committee spent some time discussing both the managed care re-procurement process and assessing the status of the redesign of the behavioral health system. The latter discussion included how to ease the administrative burden between providers and managed care plans, with more to come in future discussions. A future meeting of JMOC will be entirely dedicated to reviewing ODM’s report on the status of PBMs engaged in the flow of pharmacy drugs to pharmacists/pharmacies and ultimately Medicaid enrollees. The report was not ready for release at Thursday’s JMOC hearing.
The recent decline in enrollment for children has been especially concerning.
The hearing concluded with a discussion around continued communication between the executive and legislative branches of government on spending authority and intent, and how to engage beyond the scope and timing of state budget hearings. Earlier this year, ODM authorized an increase in payments to managed care plans to accommodate higher than expected morbidity in the Medicaid expansion population. This increase fell within the authority of ODM, was shared with the legislature through the budget process and occurred when Medicaid ran under budget, overall. JMOC member Senator Bill Coley (R-West Chester) shared a desire for the administration to circle back to communicate these changes to the legislature.
ODM provided additional material at the hearing in the form of a report entitled Child Caseload Summary that examines the many factors that have contributed to enrollment declines amongst kids covered by Medicaid. As Community Solutions digs into this report, we’ll be sure to share highlights. The recent decline in enrollment for children has been especially concerning.
Stay tuned for more coverage of rollout of the myriad initiatives of ODM and JMOC’s response as the legislature gears back up in the last few months of 2019.