In April, we celebrate all that Medicaid does for public health in Ohio

By Angela Weaver, Director of Regulatory Affairs, Ohio Association of Health Plans / April 18, 2024

April is recognized as Medicaid Awareness Month, so I want to make sure to take note of it before the month is out. But I hope it’s clear to everyone how critical Medicaid is to public health, every day of every year.

At its most basic level, Medicaid, jointly administered by the federal government and individual states since 1965, ensures that low-income and disabled Americans have access to the care and services they need to live healthy and fulfilling lives. But in recent decades, especially in Ohio, Medicaid has evolved to provide so much more and to do its job far more effectively.

Thanks to managed care, almost all Ohio Medicaid members receive coordinated care focused on them as individuals, with the goal of improving their health outcomes. More than 90% of Ohio’s Medicaid population is served by one of the managed care organizations currently contracting with the Ohio Department of Medicaid (ODM): Aetna OhioRISE, AmeriHealth Caritas Ohio, Inc., Anthem Blue Cross and Blue Shield, Buckeye Community Health Plan, CareSource Ohio, Inc., Humana Healthy Horizons in Ohio, Molina Healthcare of Ohio, Inc. and UnitedHealthcare Community Plan of Ohio, Inc.

We’re excited that even more Ohioans in need could be served by managed care with statewide adoption of MyCare Ohio, which provides integrated care management to some of the most vulnerable residents: those eligible for both Medicare and Medicaid. MyCare has been a successful pilot program in 29 counties since 2014, and we’re excited that the 2024-25 state budget calls for statewide implementation by 2026.

Before the advent of managed care, the old fee-for-service health care model simply paid bills, thereby incentivizing and rewarding the volume of services and medications provided, regardless of whether they actually made patients healthier. Patients in managed care plans have access to personal case coordinators who are aware of the different health issues that may be at play and the multiple providers who may be treating someone. This helps avoid care that is duplicative or even counterproductive. Generally, providers are compensated most when patients’ health outcomes are optimized.

Ohio was a pioneer in Medicaid managed care, which is now in broad use across the country. With the Next Generation of Medicaid managed care (NextGen), launched in 2023, Ohio is going further, with a stronger than ever emphasis on the individual and on population health. NextGen addresses the “social determinants of health,” or nonmedical factors such as income, race, education, and living environment that can negatively affect a person’s physical and mental health.

On the ground, this translates into support through Medicaid for things like transportation, groceries and getting a good job — things that traditional health care wouldn’t touch but that can make all the difference in someone’s ability to get and stay healthy.

NextGen requires Medicaid managed care organizations (MCOs) to take an active role in improving public health through Community Reinvestment — an annual process in which the plans collaborate to choose and fund those most promising initiatives from applications submitted by community-based organizations. OAHP helps coordinate Community Reinvestment, and we recently celebrated the announcement of $6.9 million in grants for the coming year.

The grants, 17 in all, won’t be spent in doctors’ offices or hospitals but in communities across Ohio, paying for things including education and support for doulas in communities of color and Appalachia and a free pharmacy for uninsured or underinsured people in rural southeast Ohio. What makes Community Reinvestment so special is that the Medicaid MCOs aren’t competing, but collaborating to achieve the best health outcomes possible.

In the past year, Medicaid programs across the country including in Ohio also have focused on changes brought by the end of the coronavirus public health emergency. As a return to pre-pandemic eligibility requirements ends Medicaid coverage for some members, the plans are working to help those members find alternatives.

You can learn more about how Ohio NextGen Medicaid is making life better for millions of Ohioans here. At OAHP, we’re proud to support our member Medicaid MCOs and look forward to making this critical part of the health care system better every year.