Learn about the Ohio Medicaid Managed Care program
What is Medicaid Managed Care?
Medicaid Managed Care acts just like regular private health insurance for individuals enrolled in the Ohio Medicaid program.
In Ohio, most people approved for Medicaid are automatically enrolled for Medicaid Managed Care coverage. Shortly after enrolling in Medicaid, individuals get a letter asking them to choose a Medicaid Managed Care Plan (MCP). Once enrolled with a MCP, the plan sends a permanent card for use when seeking services from providers as well as information about the scope of coverage of the plan.
Below are the links to Ohio's five Medicaid Managed Care plans:
Medicaid Managed Care differs from the Medicare program. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Visit medicare.gov for more information about the Medicare program.
Background of Medicaid Managed Care in Ohio
The Ohio Medicaid Managed Care program was initiated in 1978 in an effort to improve access, quality, and continuity of care, while reducing the growth of Medicaid spending. Beginning July 1, 2005, the Centers for Medicare & Medicaid Services (CMS) permitted Ohio to operate the program under the authority of a State Plan Amendment. In 2006, Ohio's Medicaid Managed Care program was expanded to all 88 Ohio counties.
In January 2012, Ohio embarked on a redesign of the Medicaid Managed Care program. Changes to the program reduced the state’s administrative service regions to three, combined coverage for the Covered Families and Children (CFC) and Aged, Blind, and Disabled (ABD) populations, covered a portion of children with special needs, and implemented several other changes aimed at improving quality of care and health outcomes for individuals. Five MCPs were selected and began providing services in all three regions in July of 2013.
Ohio expanded Medicaid coverage in January 2014 to individuals making up to 138% of the federal poverty level (Group VIII). In any given month during state fiscal year 2018, Ohio’s five MCPs provided services to an average of 2.4 million Ohioans, nearly 88% of all individuals enrolled in Medicaid.
About the Medicaid Managed Care Procurement
In early 2019, Ohio Governor Mike DeWine called on ODM to ensure Ohioans get the best value in providing quality care. In response, we developed a bold, new vision for Ohio’s Medicaid program – one that focuses on people and not just the business of managed care. The new Medicaid program will be the first structural change since CMS’ approval of Ohio’s program in 2005. The procurement will ultimately result in the issuance of new managed care contracts. At a high level, the Procurement is divided into four phases:
Beginning in June 2019, the procurement process focused on collecting feedback and suggestions for improving the program from individuals who receive services through managed care, providers, advocacy groups and community-based organizations through our first Request for Information (RFI).
This feedback informed development of RFI #2, outlining our vision for a reimagined statewide managed care program. This second RFI sought input from providers, associations, advocacy groups, data and information technology vendors, and managed care organizations. Both RFIs closed on Tuesday, March 3, 2020 at 4:00 p.m. EST.
On September 30, 2020, Ohio Medicaid released its Request for Applications (RFA) for the Managed Care Procurement for those interested in becoming managed care plans for children and adults within the Ohio Medicaid program. The selected plans will be an essential piece in improving the health and lives of millions of Ohioans.
The Managed Care Procurement RFA closed on November 20, 2020. As a next step in this process, Ohio Medicaid will evaluate the responses to the RFA, and the applicants will be required to conduct oral presentations. Once oral presentations have concluded, new managed care organizations will be selected in late January 2021. Services under the new contracts are not scheduled to begin until January 2022; any changes to Ohio’s Medicaid MCOs will NOT disrupt member coverage or access to care.
Throughout future phases of the procurement process, the Managed Care Procurement mailbox will remain open as a way for providers, advocates and individuals to communicate with ODM about the current managed care program.
Future phases will focus on scoring and awarding new Managed Care contracts, and conducting a thorough transition to support individuals and providers in adopting program changes and confirming managed care organizations can meet the requirements of the new managed care contracts.