COLUMBUS: Ohio and the federal government reached an agreement Wednesday on a plan aimed at better coordinating medical care for some of the state’s sickest and most-expensive patients.
Gov. John Kasich’s administration wants to streamline the way health care is delivered to people enrolled in both Medicaid and Medicare.
Ohio has more than 182,000 so-called “dual-eligible” individuals. And while they make up only 14 percent of the total of the state’s Medicaid enrollment, they account for almost 40 percent of total Medicaid spending, according to state figures.
Coordinating care is expected to save the state and federal government $243 million in Medicaid spending through the end of 2016, said Ohio Medicaid Director John McCarthy.
The bigger benefit, he said, will be better health care. Providers, as an example, will make decisions based on need rather than whether it’s paid for by Medicaid or Medicare, McCarthy said.
“That’s our No. 1 concern,” he said, “making sure the person gets what they need.”
The federal Medicare program serves the elderly and disabled, while Medicaid provides coverage for the poor though state and federal funding.
The two programs operate fairly independently of each other. Medicare generally helps pay for doctor and hospital visits, along with prescription drugs. Medicaid typically helps pay for long-term care, such as nursing homes, among other services.
Officials worked to create a three-year demonstration project aimed at better coordinating the care of the beneficiaries in the programs.
The project would affect a portion of the dual-eligible population — almost 114,000 people living in seven urban regions. Voluntary enrollment in the program begins Sept. 1.
More than 16,000 residents in Summit, Stark, Medina, Portage and Wayne counties are covered by both Medicare and Medicaid, according to the state. All five counties are included in the demonstration project.
Federal officials had to approve the project before the state could move forward. Wednesday’s agreement makes Ohio the third state — after Massachusetts and Washington — to finalize such a plan, the Kasich administration said.
As a result of the lack of connection between Medicaid and Medicare, some patients are more costly to the system, officials say.
For instance, a patient could be discharged from a hospital to a nursing home instead of to a less-expensive home-based care because the two programs aren’t talking to each other in the same setting.
The state wants to better link the two programs so that the beneficiaries have to work with only a single entity to receive the services.
Individuals would get a care manager to help them with medical decisions and to live independently if they are still at home.
Ohio’s plan is also designed to eliminate unnecessary health tests, prevent medication errors and keep people healthier and out of emergency rooms.
