Ohio’s overhauling $20B Medicaid program, but budget could pump the brakes

“Some of the Ohio companies that have provided this service for many years, and of course their employees and everyone else, are here in Ohio. These people were concerned about what the process was and how it was going, ”Senate President Matt Huffman, R-Lima, said as he discussed the Senate budget version, according to the Columbus Dispatch.

ExploreNew Medicaid program to help children in need stay with their families

This would affect Paramount Advantage, one of the Ohio-based and headquartered bidders that just lost its bid to continue doing business with Ohio Medicaid. Paramount is operated by Toledo-based ProMedica and is appealing the decision.

CareSource, headquartered in Dayton, is another bidder who is also based in Ohio but won the contract.

It’s not clear what the proposed Ohio budget would mean for the locally based company whose primary business is the Ohio Medicaid contract. A message was left with a company spokesman.

The amendment has generated criticism and concern from some of the people who are betting for an urgent revision.

One of the hallmarks of the new system will be a specialty program called OhioRISE to coordinate care for children with complex needs. This includes children with significant mental health problems who have sometimes spent time in foster families, juvenile detention, or in several other government systems.

Every year, some Ohio parents choose to give up custody of their child, sometimes putting an adopted child back into state care because state children cover all of their expensive housing treatments. OhioRISE would help parents and children navigate these systems with experienced care coordinators and cover inpatient treatment.

The Ohio Senate budget change does not call for a revision of the OhioRISE treaty. However, critics of the change noted that the new refurbished system is full of interconnected programs that only work with the other parts, such as how OhioRISE would be paid for with savings from the other parts of the refurbishment.

Lisa Norris, who also followed OhioRISE’s proposal, ceded her 12-year-old daughter Tuesday in Franklin County because she was unable to raise the nearly $ 80,000 cash she would need upfront to secure her daughter an open dormitory treatment center. Norris said that as a seasoned special education worker, she knows the resources and there is no other way to support her daughter.

“I don’t want any other family to ever go to court and make that decision yesterday because it’s devastating,” said Norris.

The revision of the DeWine administration is already in progress. All contracts were announced and the administration did 18 months of preparatory work before the tender and obtained feedback from 1,100 different people and organizations in advance of the tender.

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“In our view, the Department of Medicaid has spent an incredible amount of time listening. They listened to providers, they listened to consumers, they listened to families, they listened to stakeholders and advocates, ”said Teresa Lampl, CEO of the Ohio Council of Behavioral Health & Family Services Providers, concerned that the proposal will ruin the work could.

Interrupting the revision would also interrupt the overhaul of Ohio Medicaid’s $ 3 billion pharmacy benefit system. The old system had been riddled with spending and transparency for years, and pharmacists celebrated the changes that were to come.

“The problem started in 2016 and only saw the light of day in early 2018. And here we are with the ball on the tee in 2021 to fix the problem, and that could throw a wrench into anything. “Said Antonio Ciaccia, 3 Axis Advisors pharmacy advisor who had been advocating change for the Ohio Pharmacists Association for years.

The new system includes five contracts already awarded: a transparent pharmacy performance manager instead of a handful of contractors; a central stop to obtain ID; a single clearinghouse for all vendor requests and pre-approval requests; a new system to coordinate services for children with complex needs; and several large insurance company contracts to manage benefits and care.

The major orders went to UnitedHealthcare, Human, Molina, AmeriHealth, Anthem and CareSource.

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