COLUMBUS, Ohio — In a scathing report to Gov. Mike DeWine, Ohio Medicaid Director Maureen Corcoran said on Tuesday the agency overseeing health care for 3 million poor Ohioans “as we inherited it, was a mess.”
The 13-page report blasts the administration of former Gov. John Kasich, accusing it of failing to protect the privacy of hundreds of beneficiaries, erroneously booting some from the rolls, forcing some of the most vulnerable to seek treatment out of state, short-changing health care providers, and ignoring legislative initiatives.
Among the many problems with a benefit system adopted under Kasich, the report said it “sometimes incorrectly links newborns to individuals who are not their actual parents. For example, we discovered an instance where the system linked a newborn to an eleven-year-old child.”
And, a long-lingering caseload backlog and error rate in Ohio’s system for determining Medicaid eligibility has led federal regulators to threaten the state with $6 billion in penalties.
“This is not personal, this is not denigrating,” Corcoran told the Dispatch of the blistering assessment. “It is about being open about realities held in secret.”
Corcoran, tapped to lead the department when DeWine took office about a year ago, said “the challenges” have required her to redirect “numerous resources — both human capital and financial resources — to repairing issues inherited by the DeWine administration.”
Corcoran’s report to DeWine noted the $1.2 billion Ohio Benefits system, bought in 2013, is riddled with 1,100 defects, including:
• Privacy incidents affecting more than 700 members, including incidents where members received mail for other members and members being able to access the portals of other members.
• The system ascribed incorrect dates for renewals causing late renewals or in some cases failing to trigger a renewal at all.
• County workers report that the Ohio Benefits system is causing some individuals’ applications for benefits to disappear.
“This could have been prevented, or at least mitigated, had the past administration acknowledged and addressed it, rather than kicking the can down the road,” Corcoran said
The report also said in-patient addiction services were threatened.
“The federal government notified the prior administration of its very serious noncompliance with federal regulations… which can result in the loss of all Medicaid funding for individuals receiving residential treatment for substance abuse disorders,” the report said. “And the federal government communicated its intent to act. According to information prepared by the prior administration, this loss of funding would impact approximately 4,000 beds that are essential to helping Ohio recover from the opiate use crisis that has ravaged Ohio communities.”
Corcoran said that her predecessors fell down in terms of offering adequate services to children. In 2018 and before, more than 100 children received intensive behavioral support services every day outside of Ohio because Medicaid services did not exist in-state to meet their unique and intensive needs.
Also, transitioning behavioral health services into managed care under the Kasich administration was “hasty, with woefully inadequate guidance to providers and managed care plans,” the report said, “that some community provider agencies went out of business.”
“In July 2018, the first month of managed care implementation, less than one third of the normal amount of funds was paid out to community providers. The first six months of billing implementation resulted in providers being paid 43% of the dollars they were owed for services rendered during that time period.”
Roughly 700,000 Medicaid beneficiaries receive about $1 billion in behavioral health services a year.
According to the report, the Kasich administration also neglected a 2017 legislative directive to seek approval from federal regulators to implement work requirements for some Medicaid beneficiaries.
“The approval of the waiver did not occur until March 2019 after the DeWine administration picked up the negotiations with (the Centers for Medicare and Medicaid Services),” Corcoran wrote. “While recognizing that the federal waiver process takes time, this extended period of time of 21 months does not suggest that this was a priority.”
The report also raises questions about the Kasich administration’s effort to oversee pharmacy benefit managers hired to administer drug benefits in the managed care program in the wake of a Dispatch investigation which found two PBMs had billed the state more than they reimbursed pharmacists to fill prescriptions, pocketing the difference.
The report highlights a host of policy initiatives by both the legislature and DeWine administration aimed at reigning in PBMs, including a stricter and more transparent payment system, plan to rebid contracts with the managed care plans that hire the pharmacy middlemen, and move to a single PBM.