Ohio
drops 2 for Medicaid contracts, adds 2 others
Thursday June 7, 2012 8:15 PM
ANN
SANNER
The Associated Press
COLUMBUS,
Ohio (AP) — Ohio officials dropped two managed care organizations Thursday that
had been tentatively awarded new Medicaid contracts and picked two other plans
after weeks of legal review and further examination over how each application
was scored.
The
decision came after five of six companies that lost bids for contracts filed
formal protests with the state, claiming flawed and inaccurate scoring in the
application process.
The
eventual contract winners will provide health care services to more than 1.6
million poor and disabled people, or roughly two-thirds of the state's Medicaid
population. The contracts provide billions in government work to the companies.
In
April, the state selected the winning bidders: Aetna Better Health of Ohio,
CareSource, Meridian Health Plan, Paramount Advantage and United Healthcare
Community Plan of Ohio. The winning organizations were the highest-scoring
applicants in the state's contract process.
The
plans were judged on certain components, including experience, care management
and clinical performance. The provider network was also a factor, but not as
heavily weighted.
Ohio
Medicaid Director John McCarthy said Thursday that a review of the applications
changed how points were awarded, and meant Aetna Better Health of Ohio and
Meridian Health Plan of Ohio would no longer get the contracts.
Instead,
Molina Healthcare of Ohio Inc., a subsidiary of Molina Healthcare Inc., and
Buckeye Community Health Plan, a subsidiary of Centene Corporation, were
picked.
The
contract awards are preliminary. The organizations must first pass an
assessment, in which they must prove that they will be ready and able to
provide care when enrollment begins in January.
"There
were some specific areas that plans had pointed out that when we reviewed, we
needed to make changes," McCarthy said.
For
instance, the review found that Meridian Aetna lost a large amount
of points for experience because it did not provide evidence of full liability
for certain plans with other states.
McCarthy
said he didn't know whether contract changes as a result of protest were
unusual, only that they can happen.
About
$5.1 billion in state and federal money was paid to all the managed care plans
in the fiscal year that ended June 30, 2011, according to the Ohio Department
of Job and Family Services. The state is restructuring its Medicaid contracts
as part of a package of changes expected to save more than $1.5 billion over Ohio
Among
other changes, state officials are raising performance expectations in the
contracts by linking part of each Medicaid managed care plan's payment to
standards aimed at making people healthier. The plans also will have to develop
financial incentives for hospitals, doctors and other providers that are tied
to improving quality and patients' health.
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