Ohio Medicaid Priorities

Ohio Medicaid Expansion Coalition

February 22, 2019

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Medicaid is Ohio’s largest health payer.

Provides health care coverage to

3 million Ohioans.

Network of

130,000 providers.

December 2018 enrollment: 2,837,709

• Over half of Ohio births covered by Medicaid

• Over 1.2 million children served by Medicaid

• Approximately 36,000 children in foster care served by Medicaid

State Fiscal Year 2018

• Individuals receiving behavioral health services: 843,694

• Nearly 90% covered by a managed care plan

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Medicaid Enrollment Overview

Decline in Medicaid Enrollment

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Decline in Total Medicaid Enrollment

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Collaboration

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Federal State Local

Centers for Medicare and Medicaid Services

(CMS)

Governor’s Officelegislators

legislative committeessister agencies

advocacy groupsassociations

88 county JFS officescommunity boards

area agencies on agingcommunity leaders

individualsadvocates

community partners

• Recovery Ohio

• Opportunity for Every Ohio Kid

• Guarantee Coverage and Reduce Costs in Healthcare

• Innovate Ohio

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Governor DeWine’s Priorities for Ohio

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Recovery Ohio

Behavioral Health Redesign Update

• Communication went out to providers on 2/19 that included the following action steps:

» Managed care plans will not be seeking involuntary recoupment of any contingency payments until further notice.

» Analysis for the months of July, August, and September 2018 will be used to determine outstanding accounts receivables due to underpayments and incorrect denials that are owed to the provider.

» Providers may inquire about the amount of dollars to expect by email (BH-Enroll@medicaid.ohio.gov).

» This process will be repeated for August and September in the very near future, followed by next steps regarding October, November and December.

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Recovery Ohio

• Increase substance use treatment capacity in Ohio

• Stabilize the recently restructured behavioral health benefit package of services

• Work with CMS to develop potential Demonstration Waiver for substance use disorder services

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Recovery Ohio

• Consider opportunities for comprehensive eligibility and supports for the perinatal period, particularly for pregnant women with substance use disorders and their infants

» Examine coverage timeframes needed for new moms to rebuild their lives in recovery while ensuring that appropriate well checks are completed

» Reduce some of the pressure on Ohio’s foster care system

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Opportunity for Every Ohio Kid

Increase Home Visiting

• Work with sister agencies and local communities to close the racial gap in infant mortality

• Leverage close partnerships with ODH and community partners to also support centering and community health worker programs

• Automate managed care plan and county notification of all pregnancy and referrals to home visiting programs

• Eliminate preterm birth specifically for African American women

» establish eligibility requirements and provide a system of care to more reliably deliver proven prevention and treatment with attention to the cultural competencies

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Medicaid Home VisitingInvestment in Community Infant Mortality Efforts

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• ODM invested in a “bottom up” strategy to allow communities to determine what services they needed to address the infant mortality disparity in Ohio

» Over $26M for each biennium (SFY 16-17 and SFY 18-19) was distributed from the Medicaid managed care plans to communities at highest risk for infant mortality

» Over $7.5 million dedicated specifically to home visiting for almost 2000 women in the last 2 years

Increase Access to Mental and Physical Health Services in Every Ohio School• Collaborate with ODE and MHAS to leverage school-based

health care networks to meet health needs of students and improve academic outcomes

» Increase access to the health system for children, especially minority children

» Reduce barriers to receiving coordinated behavioral health services to address issues of anxiety, depression, attention deficit disorder, drug use and suicides

» Prevent behavioral health conditions through screening for trauma and events and addressing social determinants adverse childhood s of health

» Examine how telehealth services can enhance access to behavioral and physical health for students

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Reform the Foster Care System in Ohio• Help youth and families move beyond the child protection

system with supports or services to address their trauma, opiate addiction, or other critical health and behavioral health needs

• Continue work on the recommendations of the Joint Legislative Taskforce on Multi System Youth of the 131st and 132nd sessions of the Ohio General Assembly to prevent children, youth and their families from reaching the point of requiring the intervention of child protection agencies

• Utilize new behavioral health redesign services to parents—improving the health of parents to return children as quickly as possible.

• Work with ODJFS and other child-serving agencies to plan and implement the Family First Prevention Services Act 17

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Reduce Cost in Healthcare

Reasonable Work Requirement for Medicaid Expansion-Covered Individuals

• Connect people to jobs waiting to be filled, including over 100,000 jobs on OhioMeansJobs

• Connect individuals with appropriate job training programs to prepare them for one of many in-demand careers in Ohio

• Seeking approval for a work requirement that meets the requirements of Ohio law (ORC 5166.37) and new CMS guidelines

• Ongoing analysis based on current data and updated implementation requirements and timeline

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Increase Pharmacy Transparency

• Require Medicaid managed care plans to improve pharmacy transparency using a transparent pass-through pricing model

• Continue to increase accountability regarding pharmaceutical purchasing to get the best value for Ohio taxpayers

• Make transparency a priority in the planned re-procurement for Medicaid managed care services

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Improve the Medicaid Managed Care Strategy

• Increase quality withholds to the managed care plans tied to enhanced performance standards for quality and improving outcomes

• Review managed care strategy and the role of pharmacy benefit managers in the program

• Engage individuals, advocates, and partners as we procure innovative new managed care contracts that will improve the quality of services and care to those we serve

• Secure the best deal of Ohio taxpayers

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Innovate Ohio

Data and Technological Innovation and Greater Transparency

• Work towards an integrated data environment that encompasses a data lake and Medicaid Enterprise Data Warehouse to enhance data sharing, analytics and collaboration among state agencies and stakeholders

• Pursue the use of Electronic Health Records (EHR) to enable enhanced predictive analysis to help measure and track the quality of health care services by using near real-time clinical data

• Implement a best-in-class Ohio Medicaid Enterprise System (OMES) to replace the current Medicaid Information Technology System (MITS) and add additional functionality

• Improve access to care through expanded telehealth services 23

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We look forward to working with individuals, advocates, and partners to better serve all

Ohioans and future generations.