As the July 1, 2022, implementation date of the Next Generation Medicaid Managed Care program approaches, we are beginning to receive more information on the changes for the next generation managed care plan for Medicaid. The Ohio Department of Medicaid (ODM) hosted stakeholder sessions in February to share the transition enrollment plan. Open enrollment for the seven plans effective on July 1 will begin on March 1. Click here to download the slides from the listening sessions.

Enrollment in the new Medicaid Managed Care Organizations (MCO) will follow a rolling schedule. If a Medicaid member selects a plan between March 1 and June 11, 2022, that plan will be effective July 1. If a Medicaid member selects a plan from June 12 to July 31, that plan will be effective August 1. Additionally, Medicaid members will have an extended open enrollment and will have the option to change plans from July 1 to November 30. If a Medicaid member selects a new plan during this time, they will start on the new plan the following month. If a Medicaid member does not select a plan, they will remain on their current plan. If their current plan is Paramount, they will be transitioned to Anthem.

FFS Medicaid Pool: Any new Medicaid member enrolling from March 1 to June 30 will be entered into Fee-for-Service Medicaid and then will be assigned to a managed care plan beginning July 1. Providers may experience an increase in FFS billing to ODM from March to July of 2022.

Medicaid will be publishing information for members and providers about the plans and their benefits. Providers can share this information with clients and inform them of which plans their organization is a network provider. Providers cannot encourage clients to select one plan over the other but can share information and resources with the client to help them make the best decision for their service/provider needs. The Ohio Council anticipates release of member and provider toolkits and resources in the coming days.

Medicaid PHE Unwinding:  Complicating the 7/1/22 planned Next Generation Medicaid managed care enrollment is the possibility of the end of the federal public health emergency (PHE).  One of the first requirements that would come back online when the federal PHE ends is Medicaid member eligibility redeterminations  The federal government has committed to giving states 60 days’ advance notice prior to HHS ending the federal public health emergency to allow states to begin the “unwinding” process of waivers and other regulatory changes necessitated by the pandemic.  Medicaid member eligibility redetermination will be an ODM priority as the Ohio General Assembly has given ODM 60 days to complete redetermination following the end of the federal PHE.  Meaning Ohio will have 2 months to prepare and 2 months to complete the redetermination process for all Medicaid enrollees. ODM is prioritizing upgrades to Ohio Benefits to enhance passive enrollment process for certain groups where documentation necessary for redetermination is otherwise available, for example people with SSI/SSDI. With the implemented and planned upgrades to Ohio Benefits, the prediction is that only about 20% of Medicaid members will need to present at their local CDJFS to complete redetermination in person.  Provider organizations will be instrumental in sharing this message with clients and identifying those who may need to re-determine in purpose – and help clients understand how this is separate from Medicaid managed care enrollment.

To support redetermination efforts, ODM is encouraging Ohio Medicaid members to update their contact information and asking for help from providers to share this message with clients. When an Ohio Medicaid member updates their contact information, it helps make sure that ODM and the Medicaid MCOs can reach them to provide important updates about their Ohio Medicaid managed care plan and coverage.