Message from the Ohio Department of Medicaid Director
August 1, 2021
With the onset of COVID-19, Ohio faced mounting threats to the health and well-being of our families, and communities. And the risks posed placed Medicaid at the forefront of the state’s response. As unemployment rose, thousands relied on Medicaid for health care coverage. The need to physically distance called for Medicaid to enact new and expansive emergency rules to enable continuous access to health care services and support.
Enhanced federal COVID-19 funding through Ohio’s Medicaid program strengthened the state’s fiscal outlook as well as its response to COVID-19. Not only did a $210 million cut to Medicaid’s budget in May 2020 enable the Medicaid budget to end the fiscal year within our legislative spending authority despite rising caseloads, but nearly $2.4 billion in flexible federal relief dollars came through the Medicaid program.
The Coronavirus State and Local Fiscal Recovery Funds provide substantial flexibility for each government to meet local needs– including support for households, small businesses, impacted industries, essential workers, and the communities hardest hit by the crisis.
These additional federal dollars provided Ohio, a substantial infusion of resources to meet pandemic response needs and build a stronger, and more balanced economy as the country recovers. Ohio had broad flexibility to determine the best use of the funds within select categories which resulted in much-needed relief packages including rental and utility assistance and small business relief grants to help these employers through the crisis.
An Unexpected Silver Lining
COVID-19 brought with it an unexpected outcome – namely, the significant expansion of telehealth services. By relaxing requirements and expanding technology options, Medicaid recipients leveraged telehealth as a bridge to care. We learned a great deal in the process.
Early data showed telehealth use skyrocketed during the initial months of the COVID-19 State of Emergency. In March 2020- before the COVID-19 State of Emergency- the average claims per month for physical health service and mental health and addiction service telehealth claims was 2,500, compared to the 235,000 claims made in April 2020- after the COVID-19 State of Emergency. The use of telehealth was crucial in preventing health care disruption as the relaxing of telehealth rules came during the closure of elective in-person procedures.
1,656,760 Medicaid members took advantage of telehealth services, and encounters grew exponentially, filing 4,199,380 telehealth claims between March 2020 and March 2021.
Most remarkable was the use of telehealth to provide critical behavior health services. During the year, as rates of depression grew nationally, Ohio Medicaid recipients could and would continue receiving behavioral health services via telehealth, maintaining the same level of support throughout the health emergency as has been reported in previous years.
Protecting Our Most Respected Citizens – Our Parents’ Parents
COVID-19’s threat to residents of nursing, assisted living, and congregate facilities was a known factor as news stories of the Kirkland, Washington nursing facility emerged in February 2020. Ohio Medicaid covers nearly 60% of the state’s nursing facility and long-term care residents and took the lead in creating clinically sound safety, testing, and treatment policies. Working in partnership with the Ohio Department of Health, the Ohio Department of Aging, and the Ohio National Guard, Medicaid directed an aggressive COVID-19 testing effort to identify, quarantine, and treat any resident or employee of Ohio’s 1,739 nursing, assisted living, or shared facilities. Then, as limited COVID-19 vaccine supplies reached Ohio, Medicaid and our partner agencies teamed up to administer more than 410,000 vaccines to these vulnerable groups within the first few months of their availability.
Proof: The Status Quo Could Not Solve 21st Century Health Needs
The tragedies of COVID-19 made apparent the disproportionate impact on the Medicaid population. It also took a spotlight to the geographic barriers that have long been a challenge to our health care system. Ohioans residing in rural or small communities and in the Appalachia regions of the state historically have far fewer options for seeking care. Absence of broadband infrastructure limited the use of telehealth, further exacerbating the problem.
Although Medicaid organized a statewide health care structure to ensure Ohioans living in regions with sparse health care resources could receive the same quality of support as those residing in metro areas, other important health preventions and early interventions fell behind.
The pandemic reinforced that the Medicaid managed care structure that Ohio relied on for 15 years needed improvements to address the health challenges of the 21st century. Following more than a year of extensive outreach, stakeholder input strengthened Medicaid’s procurement strategy, providing both the insights and the resolve to do better for the people we serve. During fiscal year 2021, Ohio Medicaid introduced a series of procurements that would identify for the state a consortium of health care payors, technologists and specialists who embraced Ohio’s vision for the future and earned contracts to take Medicaid forward.
The journey also fueled our call for a population health approach that could measurably elevate the well-being of Medicaid recipients and the public at large.
The agency introduced new contract language requiring Medicaid managed care organizations – who cover more than 90% of the state’s Medicaid population – to invest in staff and provider training to heighten awareness of hidden biases. The contract also requires plans to invest earnings in developing community relations and resources to advance local supports and services.
In late 2020, Medicaid redesigned its managed care quality program to introduce five health initiatives targeting specific Medicaid populations and health care gaps. Managed care plans were asked to work together to achieve collective impact in reducing the number of missed childhood immunizations, providing social connection to congregate care residents, and
investing dollars and expertise to expand telehealth to remote areas, and more.
The fiscal year 2021 Annual Report is as much a testament to the strength, determination and resilience of our administration and staff, as it is a template for addressing ongoing, endemic health care challenges in Ohio.
I am pleased to report that Ohio Medicaid is strong, focused, and more prepared than ever to advance the priorities of the DeWine administration and provide a more effective and streamlined program for our 170,000 provider partners, and the 3.1 million Ohioans we serve.