MEDICAID MANAGED CARE

The Ohio Department of Job and Family Services (ODJFS) is the only state agency with responsibility for implementation and administration of the Ohio Medicaid program. 

Managed Care Plans (MCPs) cover Medicaid consumers in the Covered Families and Children category, which includes Healthy Start and Healthy Families, and, as of December, 2006, most non-institutionalized Medicaid consumers in the Aged, Blind, and Disabled eligibility category. The program currently operates under a 1915(b) waiver approved by the Centers for Medicare and Medicaid Services and administered by the Bureau of Managed Health Care (BMHC). BMHC's responsibilities include enrolling and dis-enrolling Medicaid consumers into and from MCPs, assuring access to quality health services, and monitoring MCP performance. 

ODJFS/OAHP/OHA Medicaid Managed Care Task Force

In response to member concerns, OHA staff, along with representatives of the Ohio Association of Health Plans and ODJFS convened a Medicaid Managed Care Task Force.  The task force collaborates on Medicaid managed care operational issues that do not require legislative or regulatory intervention. 

NEWS

4/21/2008:: ODJFS announced Buckeye Community Health Plan is terminating its Aged, Blind and Disabled (ABD) Medicaid Managed Care Plan (MCP) contract in the Northwest Region effective June 30. This termination affects 4,730 ABD consumers currently enrolled with Buckeye in the Northwest Region, but does not affect Buckeye's Covered Families and Children enrollees. ODJFS will soon begin written notification of those enrollees affected by this change. All affected Medicaid ABD enrollees will be provided an opportunity to select from among the two remaining MCPs, Anthem and CareSource. ODJFS will also include information on its Bureau of Managed Health Care Web site.

4/04/2008:: OHA requests second round of data in its Medicaid Managed Care Plan (MCP)  accounts receivable (A/R) survey. Started in March, and reflecting hospital-specific claims processing performance for the eight Ohio Medicaid MCPs back to the first of the year, OHA's simple, online questionnaire asks for data on days-in receivables, bill rejection rates, and claims processing abilities.  OHA will issue its first report to the membership in mid-May and will use the data in its work with the OHA/OAHP/ODJFS Medicaid Managed Care Task Force. The electronic survey and detailed directions are both available on the OHA Web site.

1/25/2008 :: ODJFS announces Anthem managed care plan CFC pullout. Anthem Blue Cross Blue Shield Partnership Plan will end its Covered Families and Children provider agreement with ODJFS effective March 31, affecting approximately 147,000 enrollees in three regions. Additional details available here.