Innovation Ohio · January 27, 2022

DeWine Admin’s Planned Medicaid Change Would Threaten Coverage for Millions of Ohioans

Today, Desiree Tims, President and CEO of Innovation Ohio Education Fund (IOEF), and Franklin County Board of Commissioners President Erica C. Crawley held a virtual press conference to discuss a planned DeWine Administration Medicaid adjustment, which could force two million Ohioans to change healthcare coverage.

A recording of today’s press conference can be viewed here.

“The planned change would essentially kick every Medicaid member off their plan and then force them to reselect a plan, even if it is the same one they currently have. Individuals could experience obstacles or disruptions to care, such as having to change doctors, finding a new pediatrician for their child, or a new hospital system to meet their plan’s criteria,” said President Crawley. “The administration has failed to thoroughly prepare for this disruptive change in healthcare coverage for Medicaid enrollees.”

The DeWine Administration’s policy change would require all consumers participating in Medicaid managed care — over 2.9 million Ohioans — to take action to keep their current plan or risk being assigned to a new plan by computer algorithm.

Commissioner Crawley penned an op-ed on this subject back in July of 2021, and IOEF confirmed the commissioner’s concerns in December 2021 withan analysis of the DeWine Administration’s intended deviation.

IOEF’s reviewfound that this new policy could result in two million or more Ohioans experiencing a change in healthcare coverage.

“Millions of Ohioans could be forced to find new doctors and disrupt their current plan of care. Many could discover that their longtime provider is no longer covered by their insurance when they call to make an appointment,” said President Tims. “If this plan is rolled out too quickly or without intensive preparation, it could cause significant confusion and unnecessary stress for millions of Ohioans and healthcare providers.”

The change, scheduled for July 2022, coincides with the rollout of a new set of managed care plans. Last year, the DeWine Administration announced that it was renewing the contract of four of the five existing managed care companies, while one — Toledo-based Paramount Advantage — was not selected for renewal. Three new providers were selected to join the four incumbent plans beginning in July.

Before the policy change, the Ohio Department of Medicaid allowed members to change healthcare plans during the annual open enrollment period, but no action was required for a member who wished to stay on their current plan. Per the DeWine Administration’s new policy, even consumers whose provider was retained will be forced to affirmatively state their intention to keep their current healthcare plan. Medicaid members who do not make this proactive effort will be reassigned to one of now-seven providers.

“This change in the enrollment process is essentially a group of administrators saying they are going to reach out to our constituents, in an undetermined way, and if they don’t hear back, they are going to change their health care,” said President Crawley. “Further the administration needs to have a thoughtful plan on how to provide resources to counties. Currently, Franklin County will need to process over 460,000 Medicaid cases within 90 days due to the ending of the public health emergency while processing new cases and preparing for these changes in managed care plan enrollment. The state should not make these changes an unfunded mandate on counties.”

IOEF’s policy review identified several outstanding questions regarding how the plan re-selection process will work. 

“The Department of Medicaid will need to deploy a highly targeted and comprehensive outreach strategy to let Ohioans know if and when they need to reaffirm their existing provider. And the affirmation process needs to be exceptionally user friendly. Otherwise, it’s likely that hundreds of thousands of Ohioans will be reassigned,” said President Tims. “Lawmakers should put the brakes on implementation and push for answers before this process begins.”