Amidst uncertainty around the fate of Medicaid work requirements
as they are tested in two separate cases this month, Ohio became the ninth
state to gain section 1115 demonstration authority to tie work-related
provisions to Medicaid coverage.
As of Jan. 1, 2021, certain individuals in Ohio's adult Medicaid expansion population must participate in community engagement activities for at least 20 hours per week (80 hours on average per month). Ohio estimated that approximately 36,000 out of the 710,000 beneficiaries expected to be in the adult Medicaid expansion group would not be considered exempt and would need to demonstrate compliance with the work requirements.
CareSource, the largest Medicaid MCO in Ohio with 45% market share, "looks forward to partnering with the state to support work requirements and the community engagement waiver," according to a statement from Steve Ringel, Ohio market president for the insurer.
On March 14, U.S. District Judge James Boasberg heard two separate cases challenging Medicaid work requirements in Arkansas and Kentucky and expects to rule by the end of the month.
"What is uncertain is whether Judge Boasberg will soon rule again against the work requirements and impose a nationwide injunction that could arrest other states from pursuing such initiatives," observes Alex Shekhdar, founder of Sycamore Creek Healthcare Advisors.
For the MCOs that serve as state partners, "…adding community engagement requirements to a state Medicaid program creates additional administrative burdens for plans that might not be recouped through capitation," warns Shekhdar. "If the courts eventually strike down these programs, these burdens become 'sunk costs' to the plans."
From
RADAR on Medicare Advantage
As of Jan. 1, 2021, certain individuals in Ohio's adult Medicaid expansion population must participate in community engagement activities for at least 20 hours per week (80 hours on average per month). Ohio estimated that approximately 36,000 out of the 710,000 beneficiaries expected to be in the adult Medicaid expansion group would not be considered exempt and would need to demonstrate compliance with the work requirements.
CareSource, the largest Medicaid MCO in Ohio with 45% market share, "looks forward to partnering with the state to support work requirements and the community engagement waiver," according to a statement from Steve Ringel, Ohio market president for the insurer.
On March 14, U.S. District Judge James Boasberg heard two separate cases challenging Medicaid work requirements in Arkansas and Kentucky and expects to rule by the end of the month.
"What is uncertain is whether Judge Boasberg will soon rule again against the work requirements and impose a nationwide injunction that could arrest other states from pursuing such initiatives," observes Alex Shekhdar, founder of Sycamore Creek Healthcare Advisors.
For the MCOs that serve as state partners, "…adding community engagement requirements to a state Medicaid program creates additional administrative burdens for plans that might not be recouped through capitation," warns Shekhdar. "If the courts eventually strike down these programs, these burdens become 'sunk costs' to the plans."
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