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Next Generation of Ohio Medicaid Managed Care
Next Generation of Ohio Medicaid Managed Care

In 2019, the Ohio Department of Medicaid (ODM) launched the Medicaid Managed Care Procurement process with a bold, new vision for Ohio’s Medicaid program – one that focuses on people and not just the business of managed care. This is the first structural change since CMS’ approval of Ohio’s program in 2005.

With the implementation of the next generation of Medicaid managed care in Ohio, ODM intends to put the individual at the center of focus and improve the design, delivery, and timeliness of care coordination.

Goals of the Next Generation of Ohio’s Medicaid Managed Care Program

Through this effort, we are working to achieve the following goals:

Improve wellness and health outcomes. To improve health outcomes and support individual wellness, ODM intends to formalize coordinated care partnerships between community-based organizations and managed care organizations that will reduce infant mortality and preterm births, increase healthy behaviors, promote tobacco cessation, and address health care inequities.

Emphasize a personalized care experience. The RFI invited ideas that strengthen the managed care organization and provider capabilities to deliver more personalized care. ODM looks to improve member-provider communications, employ technologies to increase consumer engagement and support programs to enhance wellness behaviors and outcomes for individuals and their families as they access a continuum of care tailored to their unique needs.

Support providers in better patient care. In order to better support providers, ODM plans to employ best practices to reduce administrative burdens such as centralized credentialing, standardized authorizations, and simplified medication management.

Improve care for children and adults with complex needs. To strengthen care for children and adults with complex medical and behavioral health needs, ODM plans to develop a formalized model of care coordination, to tailor behavioral health services to meet the unique needs of children served by multiple state systems and children with other complex behavioral health needs, and to create robust partnerships between community-based organizations and managed care organizations.

Increase program transparency and accountability.  Program transparency through the use and analysis of real-time, reliable data can dramatically strengthen care oversight and outcomes. ODM is planning to enhance data analytics and consumer health care dashboards, such as its newly introduced unified prescription drug list, to streamline support and drive accountability across the continuum of care.

Communications about our Managed Care Program

ODM is dedicated to keeping our members, providers, advocates and others who are a part of the program informed throughout the procurement process. To learn more, click on the below video.

On Wednesday, September 30, 2020, Ohio Medicaid released its Managed Care Request for Applications (RFA) 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 will not begin until January 2022; any changes to Ohio’s Medicaid MCOs will NOT disrupt member coverage or access to care.

Check out the Request for Applications page  for additional information. For a link to the RFA, please visit the RFPs page on medicaid.ohio.gov.

The Managed Care Procurement mailbox remains open as a way for individuals, providers, and advocates to communicate to ODM about the reimagined managed care program.