Legislators demand Medicaid data
Outraged that they have been misled about spending in Medicaid’s $3 billion prescription drug program, Ohio lawmakers say they will subpoena the administration if needed for undisclosed data from a tax-funded analysis.
The chairman of the Joint Medicaid Oversight Committee said he first will call Medicaid Director Maureen Corcoran to testify before the legislative panel to explain earlier unreleased versions of the long-awaited study by a Columbus consultant received last fall by lawmakers, who have tried for years to implement reforms.
“There was always a concern about a delay in [release of the] report, that somehow the data was being massaged. The document we received was Medicaid’s rendition of a report we did not have access to. It makes it very hard to oversee the program,” said Sen. Dave Burke, a Marysville Republican and JMOC chairman.
“I don’t know what else to do at this point other than have a [hearing] on the issue and potentially solicit the Senate president and speaker of the House for my authority as JMOC chairman to issue a subpoena.”
The Dispatch reported on Sunday that the Department of Medicaid recently released earlier versions of the report on pharmacy benefit managers and internal communications about the analysis more than a year after they were first requested by the newspaper — and after repeatedly saying no earlier versions existed.
The records show the final report was reduced from 27 to 20 pages, with much of the data that was removed focusing on the performance of Medicaid’s private, managed-care companies, which hire pharmacy benefit managers to run their prescription drug programs. The pharmacy benefit managers, middlemen known as PBMS, have been accused of overcharging the state.
“We need to get an accurate and
complete picture of how Medicaid’s five managed care plans and their PBMS are operating, That’s very crucial,” said Rep. Thomas West, D-canton. He is a member of JMOC and among the first to pursue legislation to rein in PBMS, which were charging the state far more than they were reimbursing pharmacies to fill prescriptions and keeping the difference.
“If it wasn’t for The Dispatch and all of their work around PBMS, we wouldn’t be where we are at today,” West said. “We need to push for more transparency in that process, and I thought we were on the right path, so I can’t understand why that information has not been released and am deeply concerned.”
Burke said, “I’ll use the words borderline cover-up ... it sets a precedent that any department can usurp the General Assembly and say ‘Yeah, we’ll get to you when we feel like it.”
Corcoran said it is “incorrect” that she made false statements about the report, and earlier versions “reflected when the [consultant’s] analytic work was completed, not when the final report was produced and delivered to us.”
Medicaid’s legal team said “any redactions contained in the draft versions of the report were made to protect proprietary information identified by our managed-care organizations.”
Lawmakers said it’s hard to provide oversight of the health insurance program for 3 million poor and disabled Ohioans without spending details.
“I still keep asking, what’s the status of the lawsuit?” asked Sen. Bill Coley, a Mason Republican and member of JMOC. “We’ve never seen that data. How could it take this long?”
For more than two years, the department has battled in Franklin County Common Pleas Court over the release of data from an earlier report by the same consultant, Healthplan Data Solutions. The 2018 analysis found that PBMS were charging three to six times the industry rate.
“We’ve got to get this behind us. Let’s just be open about what we have and where we are at and let’s get their recommendations on the path they’d like to go forward and get direction from the General Assembly on what their path will be,” Coley said.
Rep. Mark Romanchuk, R-mansfield, said he and other JMOC members have been frustrated by Medicaid’s failure to implement several laws regarding PBMS. The department missed a July 1 deadline for having a single PBM and has not distributed $100 million allocated last year for community pharmacies to help make up for low reimbursements. Medicaid also has not followed up on a law enacted 1 1/2 years ago to pay pharmacists for medical services to Medicaid beneficiaries in addition to compensating them for filling prescriptions.
The lawmakers also are questioning Corcoran’s past claims that she “inherited...a mess” from the previous administration.
“I’m just completely baffled as to why the defensive posture and why is there no transparency in Medicaid to the very body that funds it and crafts policy for it?” Burke said. “I’ve never seen this in my 12 years of service. I’ve never seen such a blank stare.” ccandisky@dispatch.com @ccandisky