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Medicaid subcommittee hears testimony from HMOs


More than 100 members of state and local health organizations packed a CareSource meeting room Tuesday in downtown Dayton to hear testimony before members of the Senate Finance Subcommittee on Medicaid.

Dayton was the final stop on the senators’ statewide tour, which drew health care providers and Medicaid HMOs who support Gov. John Kasich’s proposal to expand Medicaid coverage to about 270,000 newly eligible enrollees as originally called for under the Affordable Care Act.

Representatives from Aetna Better Health of Ohio, Buckeye Community Health Plan and other private insurers — who contract with the state to enroll Medicaid recipients in health plans that they administer — told the subcommittee that while the Medicaid system may be flawed, providing health coverage for low-income residents is better than leaving them with no coverage because the cost to care for the uninsured falls on the state.

In addition, Medicaid improves access to care, lowers unmet health care needs and results in better health outcomes and a better quality of life for Ohio’s low income residents.

Without a Medicaid expansion, thousands of Ohioans will fall through the health coverage cracks, including about 4,000 residents enrolled in the Montgomery County Care health care program that provides a primary care medical home for adults earning up to 200 percent of the federal poverty level.

The pilot program was funded through the county’s human services levy. But funding will dry up next year, leaving enrollees who are not eligible for Medicaid and do not have access to other health care in the lurch, Janet Grant, executive vice president of CareSource, told the subcommittee.

“The idea was to bridge that funding through until implementation of Medicaid expansion in 2014” as originally proposed in the ACA, said Grant, who’s company administers the program. “So it’s a program at risk, given some of the discussions happening here in Ohio. Obviously, that’s a concern to use because those are individuals who are making use of affordable and effective health care today.”

State legislators who stripped the proposed Medicaid expansion from Kasich’s two-year budget proposal argue that expanding Medicaid would be too costly to the state in the long run.

While acknowledging the program has flaws, most of the HMOs presented examples of how improved access to care can drive down costs and improve the quality of health outcomes. One way to accomplish this is through Medicaid payment reform that rewards providers for quality outcomes rather than the volume of services they provide.

“Working with the (Kasich) administration, the Medicaid managed care plans are implementing innovative strategies to move payment models toward paying for quality outcomes versus volume of services,” Dr. Craig Thiele, CareSource’s chief medical officer, told the subcommittee. “Not only will this result in healthier Ohioans, administrative efficiencies an cost savings will ultimately accrue to Ohio’s Medicaid program.”


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