February 7, 2023 – The Ohio Department of Medicaid launched it’s Next Generation Managed Care plans on February 1, 2023. The change is designed to improve the health outcomes for 3.6 million enrollees. There are also changes included to enhance the provider experience. 

Structural changes in the Next Generation managed care includes expanding from five to seven managed care plans. Requirements for Medicaid managed care insurance will also be renegotiated through the procurement process. 

“This is the largest renegotiation of the state’s Medicaid program in more than a decade, and it represents a fundamental shift in the way that we pay for things,” said Loren Anthes, head of policy and programs at a health tech company working with federally qualified health centers.

These changes come on the heels of an overhaul that began in 2019 when the state and Gov. Mike DeWine decided to rebid the managed care plans. The rebid was due to the State’s new focus on the individual and not just the business side of health care. 

According to the Health Policy Institute of Ohio, a statewide organization focused on health policy analysis, Ohio ranks 47th out of 50 states on health value. This means the state is spending more money and getting worse health outcomes. 

The State aims to change this with the Next Generation plan. Through the new managed care plans in Ohio, there is an emphasis on strong cross-agency coordination and partnership between MCOs, vendors, agencies, and the Ohio Department of Medicaid. 

There will also be additional supports provided, like member transportation, after-hour behavioral health crisis services, preventative care, and individualized care coordination. 

“It’s shifting the focus more onto the people who are enrolled, and those are good goals to have as you embark on a new program,” said Tara Britton, director of policy at Community Solutions, a think tank focused on health, social, and economic issues in Ohio.

For more information, on the Next Generation of Ohio Medicaid Managed care, click here.