Ohio Awards SPD HMO Contracts

The State of Ohio has awarded contracts to five insurers to provider care to 114,000 Medicare-Medicaid seniors and persons with disabilities under a pilot program that begins in 2013.

Connecticut-based Aetna, Inc. and California-based Molina Healthcare will be the lead health plans, with both winning contracts from the Ohio Department of Job and Family Services to provide care in the state’s densely populated central region. UnitedHealthcare of Ohio, Dayton-based CareSource, in conjunction with Humana Inc., and Buckeye Community Health Plan were the other contract winners. All the plans will serve three geographical regions apiece.

“People who are dually eligible for Medicaid and Medicare are among the most vulnerable populations, with multiple chronic conditions and complex health care needs,” said CareSource Chief Executive Officer Pamela Morris. “Today, they face the daunting challenge of navigating two separate programs often resulting in uncoordinated and costly care.”

The CareSource-Humana team will serve the northeast, east-central and northeast central regions, which include Akron, Cleveland and Youngstown and have 56,000 eligible lives. Centene and UnitedHealth will also be enrolling lives in the Cleveland area.

“Our experience coordinating care for at-risk individuals who are eligible for both Medicaid and Medicare in Ohio and across the country will allow us to improve health outcomes while helping reduce costs for the state of Ohio,” said Amy Schultz Clubbs, president of Molina Healthcare of Ohio. Molina’s contract includes the Dayton, Cincinnati and Columbus regions.

Molina’s recent earnings report noted its deep losses providing care for similar populations in Texas. A Molina spokesperson declined to comment on that issue.

Aside from Aetna, all the plans currently provide managed care to Ohio’s general Medicaid population.

Enrollment for the dual-eligibles begins on April 1.