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Managed Care Procurement
Managed Care Procurement

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.

Managed Care Procurement Summary

Medicaid Managed Care Procurement Award

On April 9, 2021, ODM announced the selection of six managed care plans to lead the department’s evolution of managed care services for its more than 3 million members and thousands of medical providers. Additional information about the announcement can be found in the press release and supplemental briefing document

Current Phase of the Ohio Medicaid Managed Care Request for Applications (RFA)

The selection reflects the results of intensive stakeholder engagement efforts to define opportunities to strengthen the structure of Ohio’s $20 billion managed care program. It addresses Governor Mike DeWine’s direction at the beginning of his term to re-evaluate Ohio’s managed care system with the goal of making the system more focused on individuals.  

The six MCOs selected for the next generation managed care program are: 

  • UnitedHealthcare Community Plan of Ohio, Inc.
  • Humana Health Plan of Ohio, Inc.
  • Molina Healthcare of Ohio, Inc.
  • AmeriHealth Caritas Ohio, Inc.
  • Anthem Blue Cross and Blue Shield
  • CareSource Ohio, Inc.

Ohio Medicaid is deferring for additional consideration its decision related to Buckeye Community Health Plan.  

Members will continue to receive services with their current managed care plans until the transition in early 2022 and will not lose coverage. Members will have the opportunity to select a new plan during the 2021 open enrollment period later this summer. If members do not select a plan, one will be automatically assigned to them, assuring continuous access to health care without interruption. 

Throughout 2021, ODM will conduct a thorough transition to support individuals and providers, including providing details about expected changes and assistance in navigating those changes.

Procurement “Quiet Period”

Like any procurement of this size, there are significant guardrails placed in both federal and state law regarding communications during certain periods of contract procurements. ODM must adhere to federal and state procurement requirements to ensure a fair process. As a result, ODM cannot:

  • Share details related to RFA responses received and/or award prior to official public announcements.
  • Communicate design discussions and decisions related to the managed care structure beyond what is stated in the RFA and other official public documents.

At this point in time, ODM is in the “quiet period” for the Managed Care Procurement, which dramatically limits the information available to share on an individual basis. All information ODM releases regarding the Managed Care Procurement must be at equal opportunity.

Previous Procurement Phases: Request for Applications (RFA)

In Fall 2020, Ohio Medicaid released its RFA for the Managed Care Procurement for those interested in becoming managed care plans for children and adults within the Ohio Medicaid program. After the RFA response period closed, ODM evaluated the responses to the RFA, and the applicants were required to conduct oral presentations.

The following organizations submitted applications in response to ODM’s managed care solicitation:

  • Aetna Better Health® of Ohio
  • AmeriHealth Caritas Ohio, Inc.
  • Anthem Blue Cross and Blue Shield
  • Buckeye Community Health Plan
  • CareSource Ohio, Inc.
  • Humana Health Plan of Ohio, Inc.
  • Medical Mutual of Ohio
  • Molina Healthcare of Ohio, Inc.
  • OEHP Health Plan
  • Paramount Advantage
  • UnitedHealthcare Community Plan of Ohio, Inc.

The presentation from the Pre-Application Conference is also available.

Additional details and a link to the RFA can be found on the Ohio eProcurement website

Previous Procurement Phases: Requests for Information (RFIs)

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 two RFIs. Through this effort, Ohio Medicaid received more than 1,000 suggestions and pieces of feedback, which informed the development of RFAs, Requests for Proposals (RFPs) and provider agreements to support the next generation of Ohio’s Medicaid managed care program.

Additional details on these RFIs can be found in the drop-downs below.

Request for Information #1 

In early 2019, Ohio Governor Mike DeWine called on the Ohio Department of Medicaid (ODM) to ensure Ohioans get the best value in providing quality care. To inform the process, we launched our first RFI to collect feedback and suggestions from individuals who receive services through managed care, providers, advocacy groups, and community-based organizations.

“Our mission in this process is to focus on the individual rather than on the business of managed care,” said Governor DeWine. “The request for feedback released today seeks information specifically from individuals receiving Medicaid services, providers and advocates. Their voices are vital to a just and fair managed care program.”

ODM received nearly 1,000 responses during the RFI #1 response period, which closed on March 3, 2020. Visit the What We’ve Heard From the Individuals We Serve and What We’ve Heard From Providers pages for additional details on the themes of these responses.

The public (redacted) responses to RFI #1 are available on the RFI #1 Responses page at medicaid.ohio.gov

Request for Information #2 

The feedback gathered through RFI #1 informed development of RFI #2, which outlined our vision for the next generation of Ohio’s managed care program. This second RFI sought input from providers, associations, advocacy groups, data and information technology vendors, and managed care organizations. ODM received nearly 100 responses to RFI #2. The RFI #2 response period closed on March 3, 2020.

RFI #2 was a continuation of the process initiated by Governor DeWine to implement some of the most innovative health care reforms in the country. It examined the current health care experience of nearly 3 million Ohio Medicaid consumers and offered ideas to reduce barriers, streamline access, and enhance health care delivery. 
The public (redacted) responses to RFI #2 are available on the RFI #2 Responses page at medicaid.ohio.gov.

Communicating with ODM About the Managed Care Procurement

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. Additional resources are also available, as described in the video below.