Medicaid is Ohio’s largest health payer. Over 90,000 providers deliver services for individuals insured by Medicaid. As of March 2021, an estimated 3.18 million Ohioans, including more than 1.28 million children, receive coverage for healthcare services through Medicaid.[i] This is an increase from the June 2020 enrollment of 2,984,644.
Most beneficiaries now receive Medicaid health care benefits through one of five private managed care plans (MCPs). As of March 2021, 88% of beneficiaries receive care through MCPs, 7.4% receive care through fee for service (FFS), and 4.4% have limited coverage. Ohio Department of Medicaid (ODM) pays the MCPs monthly, per person, using capitation rates. In 2017, Ohio extended managed care enrollment to additional populations that had previously been excluded from care coordination, including children in Ohio’s foster care, children in custody system, individuals enrolled in the Ohio Department of Health (ODH) Children with Medical Handicaps (CMH) Program and Breast and Cervical Cancer Program, and optional managed care for individuals with developmental disabilities enrolled on a HCBS Waiver administered by the Ohio Department of Developmental Disabilities (DODD).
The 2022-2023 biennial budget (HB 110) made investments in the next generation of Medicaid Managed Care, which focuses on the individual and will streamline administrative processes to increase transparency and improve access and care coordination. The Next Generation strategic initiatives include: enhanced managed care procurement process to renegotiate contacts between MCOs and ODM; selection of a fiscal intermediary as single point of entry for providers; Single Pharmacy Benefit Manager to manage contracts and pharmacy benefits; OhioRISE coordination for children with behavioral health needs; and centralized credentialing via ODM.
The state’s 2022-2023 biennial budget extended postpartum Medicaid coverage for women from 60 days to 12 months, as permitted under the American Rescue Plan Act (ARPA), to begin in April 2022. The budget also maintains initiatives enacted during the previous biennial budget (HB 166) but paused due to COVID-19, which aim to reverse Ohio’s infant mortality rate and provide newborns and mothers care during stages of critical development. Stakeholder engagement sessions for the Maternal and Infant Support Program (MISP) are underway (see ODM website).
The OhioRISE program (Ohio Resilience Through Integrated Systems and Excellence) is implementing a new approach to care coordination for children and youth enrolled in Medicaid with serious behavioral health needs. Enhancements include expanded treatment options and support services spanning the behavioral health, child protection, juvenile justice, health, developmental disabilities, and education systems for an estimated 55,000 children and youth.
In the 2018-19 biennial budget, Ohio implemented a rule that the state should seek federal approval for a work requirement that would apply to the Medicaid expansion population. This requirement would not apply to enrollees age 50 or older, children, pregnant women, caretakers caring for minor children or a disabled person, people receiving unemployment or Supplemental Security Income, people in drug or alcohol treatment programs, or anyone deemed physically or mentally unable to work. Of the more than 700,000 people enrolled in Medicaid expansion, it is estimated that 36,000 will need to start working or enroll in job training, education, or certain volunteer activities, for at least 20 hours per week, in order to avoid being disenrolled. The rest of the Medicaid expansion population is either already working or would be exempt from the work requirement. The Centers for Medicare and Medicaid Services granted approval for the work requirement waiver and intended to implement the requirements in January 2021; however, implementation has been delayed due to the Maintenance of Eligibility requirement associated with the COVID-19 pandemic Public Health Emergency, which is expected to be renewed for the duration of 2021.
During the past five years, ODH and ODM have transformed their relationship towards joint decision-making. In strategic planning to improve health outcomes for Ohio’s most vulnerable populations, the agencies have developed and defined common metrics, created dual data reports, and developed processes for bi-directional data exchange. To stay abreast of needs and coordination, the agencies meet bi-weekly to support data sharing and advise policy implementation and planning processes. ODH and ODM engage in numerous joint initiatives to ensure effectiveness in the state’s health care delivery system to meet the needs of women and children, as discussed throughout this application.
The Ohio Medicaid Technical Assistance and Policy Program (MEDTAPP) enables the use of federal Medicaid administrative funds to identify barriers and improvements in accessing healthcare services and improving the healthcare workforce in high need areas. MEDTAPP is a partnership combining nonfederal and federal funds to support the efficient and effective administration of the Medicaid program. This formal state-university partnership is driven by a multi-agency agreement (available in section V. Supporting Documents) between GRC and ODM, ODH, DODD, Department of Mental Health and Addiction Services, Department of Higher Education, Department of Aging, and the Department of Education. Projects include workforce development; maternal and infant health; health services research and data, including the Ohio Medicaid Assessment Survey (OMAS); and integrated physical & behavioral health. MEDTAPP MCH projects are implemented by the Ohio State University Government Resource Center and include:
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Past projects:
- The Ohio Progesterone Promotion Project, in collaboration with the Ohio Perinatal Quality Collaborative (OPQC), engaged maternity care providers to increase screening for the need for progesterone and utilization of progesterone when indicated.
- The Ohio Type 2 Diabetes Learning Collaborative worked with obstetric, primary care, family medicine, and ODH Home Visiting providers to increase postpartum visit and glucose screening rates among women at high risk for developing Type 2 Diabetes.
- The Pregnancy Risk Assessment Form (PRAF), a collaboration with OPQC, started as a paper form completed by Medicaid obstetric providers at the first prenatal care visit to identify risks for intervention/referral needed to improve birth outcomes. The PRAF 2.0, or ePRAF, is an electronic version of the same form, and projects focus on improved use of the ePRAF to facilitate communication among pregnant women and their care providers and facilitate referrals to ODH evidence-based home visiting.
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Ongoing projects:
- Smoke Free Families quality improvement projects, in collaboration with the Ohio Chapter of the American Academy of Pediatrics, implement the 5As of smoking cessation in pediatric practices to improve caregiver screening and referral for smoking cessation services. Extensive resources for supporting families and providers were developed.
- The Ohio Pregnancy Assessment Survey (OPAS) is Ohio’s PRAMS-like survey. OPAS began in 2016 after Ohio had participated in PRAMS from 1999-2015. By implementing our own survey leveraging MEDTAPP funds, OPAS provides county-level estimates for Ohio’s 3 largest counties and larger sample sizes. In addition to the statewide OPAS questionnaire, Ohio implemented an opioid supplement starting in 2019 and COVID-19 supplement in 2020. Preliminary data from the opioid supplement effort was published by CDC in July 2020.
- ODH initiated a stillbirth survey in 2019 with methodology identical to OPAS, but the target population drawn from fetal death certificates rather than live birth certificates. The Ohio Study of Associated Risks of Stillbirth (Ohio SOARS) survey will provide ODH with timely population-based data to better understand maternal experiences and behaviors prior to, during, and immediately following pregnancy among women who have recently experienced a stillbirth to inform targeted interventions.
- OPAS for Dads will collect data on new and expectant fathers’ behaviors and attitudes towards pregnancy, and the health of men during their reproductive years. The data will provide insight into gaps and disparities in male health care services and use, ultimately supporting men and improving the family’s health outcomes.
- The Ohio Women’s Behavioral Health Support Learning Collaborative aims to implement best practices to improve depression/anxiety screening, diagnosing, and providing education and follow-up for women of childbearing age with special focuses on health equity and the Medicaid population in primary care.
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