For years, The Center for Community Solutions has written about Ohio’s managed care program, with pieces outlining federal standards, current performance and value-based contracting. And, when Ohio Medicaid announced they were rebidding the contracts, we paid close attention, monitoring the feedback process, providing written comment and reviewing, in detail, the hundreds of pages worth of documents outlining the proposal. That’s why we and many other advocates across Ohio were dismayed when a last-minute amendment was offered to derail Ohio’s efforts to improve its managed care system. But it may be helpful to dispel some common myths and fact check what is happening in the statehouse around this issue.
That’s why we and many other advocates across Ohio were dismayed when a last-minute amendment was offered to derail Ohio’s efforts to improve its managed care system.
MYTH: The process was not transparent.
FACT: The procurement effort was conducted over a few years with dozens of geographically diverse meetings with patients, providers, advocates and subject matter experts. What’s more, the state created a centralized website and issued two Requests for Information, collecting dozens of pieces of feedback that are all publicly available. Once the bid was posted, details were made available to the public, testimony was provided to the General Assembly, and applicant’s information, evaluation and presentations were made available. They even made consumer-friendly educational videos!
MYTH: Ending procurement protects Ohio jobs.
FACT: It will actually lead to fewer jobs than what procurement would create. First, there will be new market entrants that will serve the entire state netting an increase in jobs created. What’s more, there are employment and workforce development incentives built into the new contracts that didn’t exist before, and there are significant design elements that make plans accountable to addressing social determinants. With that kind of focus, more enrollees will be able to access the supports they need to find meaningful, well-paying work, enabling them to leave the program and save the state money.
MYTH: OhioRISE is protected through an amendment.
FACT: The procurement effort is not a single contract – it’s a system of several contracts linking reforms to end pharmacy spread-pricing, reduce provider regulation and, yes, end custody relinquishment for multi-system youth through OhioRISE. You cannot simply extricate a single concept from a set of interwoven operational, financial and network contractual provisions without dismantling the whole thing.
MYTH: The plans have a history of providing effective, quality service.
FACT: We are ranked 47th in value, nationally, the Ohio Valley is driving rising mortality in the United States for the first time since the 1950’s, children are still being lead-poisoned, and babies and mothers are still dying are higher rates.
Let’s rely on competition to drive quality and contain costs.
Let’s rely on competition to drive quality and contain costs. The awardees are ready for that task and deserve the opportunity to prove themselves.
