Ohio Medicaid has traditionally emphasized up-front cost avoidance because it is more cost efficient and successful than "pay-and-chase."
Third-party carriers are required to share eligibility information with Medicaid for the purposes of improving cost avoidance. In State Fiscal Year 2020, Ohio Medicaid avoided $700 million in billed charges up front. Ohio Medicaid recovered $81+ million via pay-and-chase. These amounts represent state and federal shares. The federal share--typically 60 percent--is returned to the federal government. As for the state share, 40% or $32.4 million was returned through pay-and-chase activities.
Although cost avoidance provides greater value to the state, ODJFS is also committed to maximizing its pay-and-chase performance. ODJFS currently contracts with HMS to do pay-and-chase. HMS also performs tort recovery for ODJFS by identifying, managing, and recovering all Medicaid paid funds when a Medicaid recipient is involved in a tort or casualty accident or incident.