Molina, Buckeye Back In As Medicaid MCO Finalists

Ohio Medicaid has dropped potential managed care contracts with Aetna Better Health of Ohio and the Meridian Health Plan of Ohio and selected Molina Healthcare and Buckeye Community Health Plan instead under a proposed reorganization of Ohio’s Medicaid managed care program, effective January 2014. 

The decision was announced by Ohio Medicaid Director, John McCarthy, June 7, after five of six companies that lost contract bids in April filed formal protests claiming flawed and inaccurate scoring in the application process. 

Other companies that will potentially retain contracts include CareSource, Paramount Advantage and United Healthcare Community Plan of Ohio.  According to McCarthy, a review of the applications changed how points were awarded, resulting in the switch of the other two finalists. 

The contract awards are still preliminary and the finalists will need to  pass an assessment to prove they have the capability of meeting all terms in order to begin enrollments in January. The eventual contract winners will cover more than 1.6 million Medicaid recipients, roughly two-thirds of the total Medicaid population.

The plans were originally scored on  experience, care management and clinical performance. The plan’s provider network was also a factor, but not as heavily weighted. According to McCarthy, a review found that Meridian should have been disqualified because it didn’t have a necessary Ohio health insuring license at the time of application.  Aetna lost points for failing to provide evidence of full liability for plans operating in other states. 

According to the Ohio Department of Job and Family Services, about $5.1 billion in state and federal money was paid to all the Medicaid managed care plans operating in Ohio during the fiscal year that ended June 30, 2011, The state announced plans earlier this year to reduce the number of Medicaid regions, limit the number of qualified managed care plans, and require plans to compete statewide as part of a package designed to save $1.5 billion beinially.