Ohio Medicaid picks insurer to manage high-needs kids’ health care

(AP Photo/Jessica Hill, File)
(AP Photo/Jessica Hill, File)

Ohio Department of Medicaid announced Aetna is the winner of a contract to manage the health care of high-needs children.

Dayton-based CareSource had previously announced the insurance company was working with Ohio Children’s Alliance on a joint bid to manage the program, but was not selected as the winner.

CareSource officials were unable comment to comment. CareSource was not able to submit a standalone proposal for the contract, but jointly bid on the program through a new entity called Kids Care Alliance.

The state is currently working on a massive overhaul of the state’s Medicaid program. As part of that overhaul, the state is carving out a program just for helping and coordinating care for children with high needs involved in multiple state systems, which is what Aetna was selected to manage. Ohio aims to enroll 55,000 to 60,000 Medicaid-eligible children, up to age 21, in the OhioRISE program.

ExploreCareSource joins bid for state contract to care for high needs kids

However, the state has yet to announce which insurance companies will manage health care for the majority of the 3 million Ohio Medicaid members. CareSource is also seeking to be a one of the insurance plans selected for the main contract.

The program is called OhioRISE. Aetna will work with Gov. Mike DeWine’s Family and Children First Cabinet Council to implement a child and family-centric model featuring new targeted services and intensive care coordination delivered by community partners. A

Aetna also will coordinate with the state’s Medicaid managed care organizations and the new single pharmacy benefit manager to ensure medical and pharmaceutical services and supports are integrated in the child’s comprehensive health plan.

The OhioRISE program addresses gaps in Ohio’s health care system that currently result in 140 Ohio kids living out of state on any given day in order to access the behavioral health services they need. Before OhioRise, some parents told state officials that they surrendered custody of their kids because if the kids were in state custody then the state would pay for their mental health care.

Though multiple state agencies serve a majority of these children, the current absence of accountable, focused coordination to integrate these programs leaves parents facing an overly complex system of care during times of family crisis.

ExploreOhio Medicaid rolls increase during pandemic

“Too often, parents wrestle with a heart-wrenching choice to either relinquish custody of their child in exchange for life-saving services or face insurmountable health care bills and financial insolvency by seeking care alone,” said Maureen Corcoran, director of Ohio Medicaid. “The current system is at a breaking point. We spend up to $1,100 per day to send children out of state to receive supports needed, and we can do better.”

Ohio Medicaid said Aetna earned the highest total evaluation score among the four proposals received and brings more than 25 years of experience designing and developing similar programs for children and families across the country. The Medicaid department stated that within the first seven months of launching its Mountain Health Promise plan in West Virginia, Aetna reduced the number of children sent out-of-state by 9.6%, decreased the rate of in-state group home placements by 7.4%, and lowered the number of children residing in shelters by 14.5%. Additionally, Aetna recently implemented the new Supporting Kentucky Youth Medicaid managed care program.

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