Launch of Ohio’s Reformed Medicaid Managed Care System Partially Delayed
Many reforms linked to Ohio Medicaid’s Next Generation program will be delayed until the end of 2022
April 21, 2022 – In 2019, the Ohio Department of Medicaid (ODM) launched a Medicaid Managed Care Procurement process with a new vision of Ohio’s Medicaid program. The program was supposed to launch on July 1, 2022, but the state just announced that many of the reforms linked to the revamp Medicaid managed care system will be delayed until the end of the year.
Ohio Medicaid’s Next Generation Medicaid Managed Care Program Takes a Phased Approach
The Ohio Department of Medicaid (ODM) currently handles health insurance for more than 3 million low-income or disabled Ohioans. The Next Generation Medicaid program is designed to focus on people rather than just business and the bottom line.
Through the next-generation Medicaid managed care program, there is a strong focus on cross-agency coordination and partnership among MCOs and vendors. In addition, there will be increased coordination with state agencies to support specialization in addressing critical needs.
Source: Ohio Medicaid Managed Care
As the chart above shows, the next generation managed care program will work in collaboration to support social determinants of health and other non-medical factors that impact health.
Ohio’s Department of Medicaid will collaborate with various agencies, including the Ohio Department of Job and Family Services (ODJFS), County Departments of Job and Family Services (CDJFS), Mental Health Addiction Services (MHAS), Department of Developmental Disabilities (DODD), Ohio Department of Aging, among others. The goal of this is to create more individualized care plans that support the whole person.
Next Generation Rolling Out In Phases
While the next-generation Medicaid program in Ohio looks promising, the state recently announced a delay in the launch. The main program will still launch this July as planned, but many of the reforms are being pushed back as the state shifts to a phased approach.
“It seems like this new phased approach still allows them to move forward with everything, but in a way that is manageable…to maybe take smaller bites of the apple,” said Loren Anthes, who leads the Community Solutions’ Center for Medicaid Policy.
According to ODM, the program will be implemented in three stages. On July 1, 2022, OhioRISE will launch. This program treats children with complex behavioral health and mental problems in order to provide parents with the support needed to retain custody.
Other, more complicated changes, will take place later in 2022. In October 2022, Centralized Provider Credentialing will begin. The Single Pharmacy Benefit Manager (SPBM) will also start providing pharmacy services for managed care plans and members at this time.
Stage 3 will occur during the last three months of 2022. During this time, all seven Next Generation managed care plans will begin to provide healthcare coverage through the new program.
ODM is continuing to keep stakeholders abreast of the changes. To keep up to date with the Next Generation of Ohio Medicaid, visit managedcare.medicaid.ohio.gov.
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