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State Demonstration to Integrate Care for Dual Eligible Individuals & Managed LTSS Program

In December 2012, CMS and Ohio signed an MOU for Ohio’s capitated managed care duals demonstration model. Ohio and CMS will contract with Integrated Care Delivery System (ICDS) plans that will oversee the delivery of covered Medicare and Medicaid services for approximately 115,000 Medicare-Medicaid enrollees in seven regions of the state. (Source: CMS website) The plans will serve most dual eligibles age 18 and older in 29 targeted counties; the plan will serve persons with I/DD who are otherwise served in §1915(c) HCBS waiver programs or in ICF/MR facilities. Voluntary enrollment began in September 2013. (Source: CMS and Truven Health Analytics, July 2012; CMS Press Release, 12/12/2012; State Medicaid website)
Demonstration Proposal (4/2/2012)
Memorandum of Understanding (12/11/2102)

On February 11, 2014, CMS, the state, and the MyCare Ohio Plan entered into a three-way contract. On May 1, 2014, MyCare Ohio began enrolling dual eligibles in MMPs on a voluntary basis only. Passive enrollment for duals will begin on January 1, 2015. (Source: State Medicaid website; MyCare Ohio Enrollment Update; MLTSS Weekly Roundup, March 6, 2014; Ohio Medicaid Press Release; HMA Weekly Roundup, 6/18/2014) Three-Way Contract (2/11/2014)

On May 27, 2014, the Columbus Dispatch reported that Medicaid-enrolled Ohio veterans with at least a 70 percent service-connected disability may be eligible to receive free services through the Veterans Administration. The Ohio Department of Veterans Services favors the approach of letting veterans choose whether they want to rely on Medicaid or federal health benefits for long-term care and other types of health care. Senate Bill 101, introduced in 2013, would require the state to notify Medicaid-enrolled veterans that they might be eligible for federal military-related health-care benefits. State officials cannot yet say how many Ohio veterans are enrolled in Medicaid and how much money could potentially be saved by shifting care to VA medical centers. (Source: HMA Weekly Roundup, 5/28/2014; Columbus Dispatch, 5/27/2014)

On August 22, 2014, the state released a MyCare Ohio Update. According to the update, as of August 21, 2014, MyCare Ohio plans have enrolled 100,218 Ohioans, processed 488,305 claims, and paid provider bills totaling $207,974,002. The health plans are working directly with provider associations and others to make it as easy as possible for providers to convert from government-run FFS to private health plans. The update also included an implementation update. (Source: Ohio Medicaid website)
MyCare Ohio Update (8/21/2014)

On September 25, 2014, the state released a MyCare Ohio Update.  According to the update, as of September 25, 2014, MyCare Ohio plans have enrolled 100,934 Ohioans, processed 977,030 claims, and paid provider bills totaling $326,976,149.  The health plans are working directly with provider associations and others to make it as easy as possible for providers to convert from government-run FFS to private health plans.  The update also included an Implementation Update.  (Source:  Ohio Medicaid website)
MyCare Ohio Update (9/25/2014)

On October 12, 2014, the Columbus Dispatch reported that MyCare Ohio enrollees are experiencing limitations in access to care, due to delays with health home worker payments and service authorization delays.  Sam Rossi, the state’s Medicaid spokesperson, said MyCare Ohio health plans have started programs to help independent caregivers and home-health agencies quickly resolve payment problems.  (Source:  Columbus Dispatch, 10/12/2014)

On June 18, 2015, Ohio passed its biennial budget, which includes significant impacts for MCOs. The budget proposes: requiring MCOs to establish value-based payment arrangements, with 50 percent of payments value-based by July 1, 2020; forbidding managed care plans from implementing prior authorization requirements for individuals receiving alcohol, mental health, or drug addiction services other than those with a requirement under current law; and mandating Ohio Medicaid to improve upon the integrity of its managed care system by July 1, 2016. (Source: Gongwer News Service; The Daily Record, 6/19/2015)

Ohio’s State Medicaid Director recently discussed updates to the state’s duals demonstration, MyCare Ohio, with the Joint Medicaid Oversight Committee. The changes include the following: new requirements for MCOs to report to the Ohio Department of Medicaid (ODM) any major changes in provider availability that would affect 100-plus enrollees; new transportation standards, including pick-up times and keeping the member appraised of any changes; clearer payment requirements; reinforcement of the Coordination of Benefits Agreement (COBA), and; guidelines for participating plans for assigning appropriate caseload ratios. (Testimony 8/20/2015) 

On January 30, 2017, Governor Kasich of Ohio submitted his proposed budget for fiscal years (FY) 2018-2019. The proposed budget includes appropriations of $28.1 billion for the state’s Medicaid program in FY2018, and $28.8 billion in FY2019.

The budget includes proposals to improve care coordination for all of the remaining Medicaid populations that are not currently enrolled in managed care plans. Additional populations that will be required to enroll into managed care under the proposed budget are:

  • Medicaid beneficiaries receiving both home and community-based services as well as those receiving care in a facility;
  • Beneficiaries in the state’s Medicaid Buy-In Program for workers with disabilities;
  • Dual eligibles that currently are not participating in the state’s dual eligible financial demonstration, My Care Ohio; and
  • Eligible beneficiaries in the refugee medical assistance program.

Individuals served through the Department of Developmental Disabilities (DODD) will continue to be carved out of managed care and their services will remain under fee-for-service (FFS), although they will have the option to enroll in an acute care health plan.

Moving forward, Ohio will hold a procurement with the intent to select at least three MCOs to implement a new managed long-term services and supports (MLTSS) program. (Source: Budget Proposal 1/30/2017; Budget Overview 1/30/2017; Care Coordination Overview 1/30/2017)

Balancing Incentive Program

In June 2013, CMS awarded Ohio an estimated $169 million in enhanced Medicaid funds (a 2% enhanced FMAP rate). (Source: CMS BIP website)
BIP Application (3/28/2013)
Structural Change Work Plan (1/31/2014)

On September 10, 2014, the Ohio Department of Medicaid announced it surpassed the 50% spending target for HCBS one full year ahead of the federal deadline of September 30, 2015.  (Source:  State Governor’s Office of Health Transformation)
HCBS Achievement Announcement (9/10/2014)

A new report published by the Ohio Department of Medicaid notes significant improvement in the states’ Balancing Incentive Program (BIP). Ohio has reached the 50 percent spending target for home and community-based services (HCBS) as a proportion of overall long-term care funding. In June, 2013, Ohio was awarded roughly $169 million in increased federal medical assistance percentage (FMAP) by participating in BIP. (Source: Medicaid.Ohio.gov, 8/1/2015) 

Health Homes

In September 2012, CMS approved Ohio’s first Health Home State Plan Amendment for Health Homes targeting Medicaid beneficiaries with SPMI. (Source: CMS Approval Letter; State Health Homes website)
Approved Health Homes State Plan Amendment (9/17/2012)

As of June 2014, Ohio has officially submitted to CMS a second proposed Health Home SPA, but CMS has not yet approved the second Health Home SPA. (Source: CMS Health Home Proposal Status website, 6/2014; Kaiser Health Home State Plan Option website, 6/2014)

Disclaimer: This project was supported, in part by grant number 90BC0018, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.