Appeal to new Ohio Medicaid program denied

Insurance company Paramount is only contractor not to get new deal with state.

An insurance company that has challenged the DeWine administration’s overhaul of the Ohio Medicaid program lost its appeal.

Paramount, an insurance affiliate of Toledo-based ProMedica, was the only contractor part of the current system that was not picked to be part of the new system. Paramount filed a protest of that decision.

The winning bids include Dayton-based CareSource, as well as UnitedHealthcare, Humana, Molina Healthcare, AmeriHealth Caritas, and Anthem Blue Cross and Blue Shield.

Ohio Medicaid said in a 30-page response shared with the media Wednesday afternoon that Paramount’s protest was found “without merit.”

The department wrote in its denial letter that Paramount’s application did not do as well as the other plans with reflecting or incorporating the goals of the overhauled program that the DeWine administration wants to implement.

“Paramount does not appear to fully grasp or otherwise has decided not to embrace the vision for the future of the program,” the state’s response says.

Ohio Medicaid is about two two years into an effort to transform its clunky bureaucracy and re-awarding billions of contracts with a new set of spending conditions, which are intend to translate to better care for the 3 million Ohioans covered by the health insurance program for the poor and disabled.

The new system is expected to be launched in early 2022.

Paramount received the lowest score out of applicants for the two regions in Ohio that it wanted to cover, and had argued that Ohio Medicaid had abused its discretion when denying it a contract.

Many organizations that Paramount donated to over the years wrote letters of support to Ohio Medicaid. Ohio Medicaid said, however, that such letters can’t supplant the evaluation process.

Besides the now-denied challenge filed with Ohio Medicaid, the Ohio General Assembly is also considering a budget amendment that would essentially restart the bidding process. The amendment will be considered as the House and Senate decide on a final budget proposal to send for DeWine’s signature.