Ohio to rebid private Medicaid contracts
Dayton-based CareSource has 50% of Ohio’s Medicaid plans.
The DeWine administration is moving forward with its plan to rebid all of the contracts it has with private Medicaid plans.
This means CareSource, which the state has paid a total $31 billion since fiscal year 2012, will have to once again win its contract with Ohio Department of Medicaid.
CareSource manages more than half of the private Medicaid plans in Ohio. The nonprofit insurer is a major area employer, with more than 3,000 local employees, and is headquartered in downtown Dayton.
“As an Ohio-based Medicaid managed care plan, CareSource is proud of what it has accomplished for Ohioans over the last 30 years. We put the needs of our members first, and look forward to continuing to work with the state to provide quality outcomes and value,” said Stephen Ringel, CareSource Ohio market president.
In Ohio, most Medicaid dollars are not directly paid out to doctors
and hospitals. Instead, 90% of the nearly 3 million Ohioans on Medicaid are enrolled in private insurance plans and the state pays those insurance plans a flat rate per person per month.
The majority of the money that the state pays to the insurance companies is then paid out to providers. For 2017, the latest year available, CareSource reported spending about 92% of its revenue on care.
The state is now seeking feedback on what changes it should make to the agreements it has with private insurance companies and the state will then re-select which insurance companies it works with. The five insurance companies that manage Ohio Medicaid plans are now CareSource, Molina, Paramount, UnitedHealthcare and Buckeye.
Governor Mike DeWine in early January said he wanted Ohio Medicaid to rebid the contracts and last week Ohio Medicaid kicked off the rebidding process by asking for public input.
“The request for feedback released today seeks information specifically from individuals receiving Medicaid services, providers and advocates. Their voices are vital to a just and fair managed care program,” DeWine said in a statement.
Feedback is being sought about what benefits are most helpful, how individual care should be coordinated, how the insurance companies can communicate with providers and members, and about how complaints are filed and insurers’ decisions are appealed.
Anyone that would like to share their experience with the current Medicaid plan or share ideas and solutions for the new program can submit feedback online. Go to medicaid.ohio.gov and click on Managed Care Procurement in the center of the page.
The five insurance plans managing Ohio Medicaid handle one-third of all the spending in the Ohio budget, according to a report by Center for Community Solutions, which is a Cleveland think tank.
Loren Anthes, who researches Medicaid for the Center for Community Solutions, said this rebidding process is an opportunity for the state to address the ways that social problems like inadequate food and housing lead to poor health and expensive care paid for by Medicaid.
“One thing that has vexed health care delivery systems for a while has been the factors outside of health care that affect health care costs,” Anthes said. “In what ways are housing, food, education, systemic racism — these external factors — affecting outcomes and affecting costs in the system?”
Ohioans are less healthy and spend more on health care than other states. The state ranks 46th out of 50 when it comes to health value, according to a 2019 report by the Health Policy Institute of Ohio.
Anthes said the state could use better Medicaid contracts to improve outcomes and value. There’s a wide range of ways this could be done, such as insurance companies incentivizing providers to screen for non-medical problems, or allowing non-traditional services to count as medical care covered by the plans.
The insurers managing Ohio Medicaid plans, which can look at data across different systems and coordinate care for their members, are in a good position to address these social issues, he said.
Through changes in how the money is spent under the new contracts, the state could make changes that could engineer better health outcomes and further tie how it spends money to the performance of the insurance plans, Anthes said.
“Why is it that we’re sicker but we tend to pay more money? And I think that’s where this re-procurement process can set in and create a different set of conditions,” Anthes said.