Updated: 10:25 p.m. Friday, April 6, 2012 | Posted: 10:24 p.m. Friday, April 6, 2012

CareSource gets Ohio contract for Medicaid

Dayton managed-care firm gets bulk of revenue from Medicaid enrollees.


CareSource gets Ohio contract for Medicaid photo
Pamela Morris, president and CEO of CareSource.

By Ben Sutherly

Staff Writer

DAYTON — CareSource is one of five managed-care organizations that will serve Medicaid-enrolled Ohioans as of Jan. 1, the state Department of Job and Family Services said Friday.

The Ohio Medicaid contract is vital for Dayton-based CareSource, accounting for the vast majority of its $2.8 billion in revenues in 2011. CareSource expects revenues to reach $3.3 billion this year.

CareSource employs 1,217 people, including 1,031 in Dayton.

“It’s the very reason we are in business, is to serve the Medicaid population,” said Pamela Morris, CareSource’s president and CEO. “As I look back on the last 23 years, we’ve really been a mainstay of Ohio’s managed-care program.” It was the first time since 2005 that the state issued a request for applications for the entire managed care program.

The new managed care program reduces the state’s eight managed-care service regions to three, and also combines coverage for the “Covered Families and Children” and “Aged, Blind and Disabled” populations.

State officials said the selection process is a spinoff of Medicaid reforms that are expected to slow the growth in Medicaid spending by $1.5 billion during the current 2012-13 biennium.

In a prepared release, Ohio Medicaid Director John McCarthy said the new Medicaid managed-care program will be simplified, more stable, and offer consumers more choice.

CareSource and the other managed-care plans will be required to meet national performance standards to qualify for financial incentives. The plans also will have to develop incentives for providers aimed at improving quality of care and the health of Medicaid enrollees.

The four other applicants selected to contract with the state are Aetna Better Health of Ohio, Meridian Health Plan, Paramount Advantage and United Healthcare Community Plan of Ohio.

The state said the selections are preliminary, and plans will have to meet a thorough “readiness assessment.” They were among 11 managed care organizations that applied.

With the contract, CareSource will continue to care for about 850,000 Medicaid enrollees statewide. Overall, Ohio’s Medicaid managed-care program cares for:

• 1.5 million people who are part of the Covered Families and Children population.

• 129,000 people who are part of the Aged, Blind and Disabled population.

• 37,000 children with special needs.

Morris said CareSource is now looking ahead to the state’s April 16 announcement of which managed care organizations will care for “dual eligibles,” low-income seniors who qualify for both Medicaid and Medicare. CareSource last month announced it is partnering with Humana, a large Medicare Advantage provider, to serve the dual-eligible population.

Contact this reporter at (937) 225-7457 or bsutherly@DaytonDailyNews.com.


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