In 2019, Ohio paid about $17 billion to Medicaid HMOs, making it a huge business opportunity, according to the Ohio Health Market Review 2020.
Dayton-based CareSource and other insurance companies that manage Medicaid plans on behalf of the state will have to once again win their contracts i
This is also an opportunity for Ohio to rewrite its contracts to change how Medicaid dollars are spent. A frenzy of lobbyists and health care providers have already been writing Ohio Medicaid making the case for more money to their industry or changes in how the money is spent. The department has also sought feedback from people enrolled in Medicaid about what should change with the current system.
About 90% of the 3 million Ohioans who are covered by Medicaid don’t have their benefits managed directly by the state government. Instead, people get an insurance plan managed by insurance companies. These insurers get a payment per member per month and use that money to pay for their member’s health care.
Nearly half of Ohio children, half of Ohio births and the majority of nursing home care is covered by Medicaid. All kinds of things like better outcomes for opioid addiction or a more efficient use of taxpayer money in theory can be engineered by what kind of requirements a state puts in place for how Medicaid money gets spent.
By rebidding the contracts, the state can update the conditions for getting and spending Medicaid dollars and can re-select which insurers it trusts to meet its goals.
About 1.3 million Ohioans have their Medicaid plan through CareSource, making it the largest Medicaid managed care plan in the state and larger than the other four insurance plans combined.
The Dayton insurer has many business lines, but its original core business is managing Ohio Medicaid benefits. CareSource will need to once again be awarded its contract with the state to continue doing this.
The story so far: Ohio Medicaid overhaul
What’s happened: For 18 months, the DeWine administration did the leg work leading up to this bid. This includes getting feedback from 1,100 different people and organizations.
What’s new: Bids were due Nov. 20.
What’s next: Ohio Medicaid will let the winning bids know with award letters Jan. 25, 2021. The goal is for the newly rebid system to go live Jan. 5, 2022.
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