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May 3rd, 2012 By Hannah McCartney | News | Posted In: News

Changes in Ohio Medicaid Coming Next January

Experts weigh pros and cons in transition

medicaid
In yet another effort to save tax dollars and fill holes in the state budget, Ohio Gov. John Kasich and his health care advisers will streamline the state’s Medicaid system by altering the availability to care plans and condensing care regions.

There are currently 38 health plans and 10 regions in the state of Ohio, which provide services to more than 1.6 million Ohioans each year. When changes in the system are implemented January 1, 2013, the availability will condense to five statewide plans and only three geographic regions, according to a press release from the Ohio Department of Job and Family Services (ODJFS). 

The change is billed by Kasich's office as a way to simplify the way it offers coverage, eventually making a more sustainable, efficiently run program, which will supposedly trump the short-term inconveniences caused by the switch.

According to The Enquirer, Medicaid costs the state of Ohio around $4.8 billion each year — nearly one fifth of the state’s budget. Those costs continue to grow.

Bloomberg Businessweek
reports that the new plan will also mandate higher care standards and offer financial incentives to doctors, hospitals and other providers to help improve care quality and patient health.

Selected managed care organizations include: Aetna Better Health of Ohio, CareSource, Meridian Health Plan, Paramount Advantage and United Healthcare Community Plan of Ohio. Managed care organizations who lost the bid include incumbent providers Centene, AmeriGroup and Molina Healthcare, among others.

According to the Wall Street Journal, the loss of business marks a blow for those providers, who have benefited from covering "dual-eligible" patients — those eligible for both Medicare and Medicaid services. WSJ reports that dual-eligible patients are seen as a $300 billion opportunity for managed care firms. Because Ohio is pushing to start better coordinating care for dual-eligible patients, dropped insurers will likely lose a piece of that pie.

Streamlining the selection of managed care organizations available should help, in turn, streamline processes for dual-eligible patients, who often encounter difficultly in coordinating coverage with both Medicaid and Medicare services, says Jim Ashmore, performance improvement section chief for Hamilton County Department of Job and Family Services (HCJFS).

ODJFS reports that the new providers were selected using a fair, through and open application process that was “based on applicants’ past performance in coordinating care and providing high-quality health outcomes.” Although the changes are generally perceived as a positive move forward, service providers, including doctors and health centers, acknowledge that the disruption in services could cause serious confusion when recipients are forced to find new providers and obtain new Medicaid cards. In Kentucky, the three private managed care companies which provided Medicaid services to more than 500,000 patients have received an influx of care-related complaints, including inefficiency in authorizing services and payment issues. 

Ashmore challenges the notion that the transition will be a bumpy one, noting patients have little to worry about: When the transition is made, everyone will likely receive an enrollment package in the mail that will outline steps to switch over new care providers.

 
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