The dual-eligible population in Ohio makes up only about 14 percent of the total Medicaid population, according to the Ohio Department of Job and Family Services, but they account for more than 40 percent of total Medicaid spending, or about $3.7 billion, said Sam Rossi, spokesman for the Office of Ohio Health Plans, which now oversees Medicaid. Long-term care, including nursing homes, and Medicaid waivers make up “a lot” of that spending, Rossi said.
In the Cleveland market, CareSource, Buckeye Community Health Plan and United Healthcare will compete for approximately 31,000 clients in the Cleveland market, and another 9,000 in the Youngstown market.
In the Akron market, CareSource and United Healthcare will compete for approximately 16,000 dually-eligible adults.
In Southwest Ohio, Aetna Better Health of Ohio and Buckeye were awarded contracts for the dually eligible.
Nine health plans submitted proposals for the new program in May. After selections were announced in June, five health plans protested the state’s decision. Last week, the state reviewed the proposals again, but the decision was unchanged.
Enrollment will begin in April 2013, Rossi said.
People who are dually eligible for Medicaid and Medicare are among the most vulnerable populations, with multiple chronic conditions and complex health care needs,” said Pamela Morris, CareSource President and Chief Executive Officer. “Today, they face the daunting challenge of navigating two separate programs often resulting in uncoordinated and costly care.”
“Members eligible for Medicaid and Medicare deserve an integrated approach designed to help them achieve and maintain independence and lifelong well-being,” said Kevin Meriwether, Division Leader for Humana’s East Region Medicare Division. “This solution from Humana and CareSource builds on the strengths of our respective core capabilities to deliver a comprehensive, quality offering to the member.”
CareSource is a commuity-based nonprofit health plan with more than 900,000 Ohio Medicaid members, and 23 years’ experience in the Medicaid market.
Humana, headquartered in Louisville, has 5.3 million Medicare enrollees, and more than 25 years’ experience in the Medicare market.
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