Policy

Ohio bills would boost aid to Medicaid recipients

Two Ohio House proposals would create programs to help Medicaid patients manage diseases and navigate complex health problems. The bills would set up disease management and case management programs for patients enrolled in Medicaid’s fee-for-service plan. “If we’re providing medical services in the state of Ohio, [is the state] just writing checks, or should we […]

Two Ohio House proposals would create programs to help Medicaid patients manage diseases and navigate complex health problems.

The bills would set up disease management and case management programs for patients enrolled in Medicaid’s fee-for-service plan.

“If we’re providing medical services in the state of Ohio, [is the state] just writing checks, or should we actually help people?” said Rep. Barbara Sears, R-Toledo, who sponsored the bills.

The first piece of legislation, House Bill 513, would create a disease management program, with the goal of helping patients prevent and minimize complications arising from serious medical conditions. The proposal would accomplish that in part by bolstering communication between doctors and patients to ensure patients have the necessary knowledge, medication and supplies to cope their conditions, Sears said.

House Bill 514 would create a case management program for fee-for-service Medicaid patients. Case management refers to helping patients coordinate and plan, evaluate and coordinate their care, as well as develop treatment plans. The program would be aimed at patients with a variety of ailments including diabetes, asthma, lung disease and high blood pressure.

Notably, the bills would apply to patients enrolled in Medicaid’s fee-for-service plan, not its managed care plan. Under fee-for-service, patients can go to any authorized health provider of their choosing. Managed care plans limit provider options to those that are included in the plan’s provider list. Sears said Medicaid’s managed care plan already provides many of the services her legislation would implement.

Of the nearly 2.1 million Ohioans enrolled in Medicaid, about 28 percent are in fee-for-service, while the rest are enrolled in the managed care plan, said Ben Johnson, a spokesman for the Ohio Department of Job and Family Services, which administers Medicaid.

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From July 1, 2009, to April 30, 2010, Ohio spent nearly $10.8 billion on Medicaid.  The federal government reimburses Ohio for 73 percent of Medicaid costs, Johnson said.

One potential downfall of the legislation is that Sears hasn’t identified a funding source. She said the new programs would be funded by the savings derived from preventing and treating conditions before they become more costly medical complications. Asked if the lack of a funding source would hinder the bills’ chances of passage, Sears said, “That’s only an argument if someone doesn’t want to recognize the value of adding these services.”

The bills have been assigned to the Finance and Appropriations Committee.