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Megabucks for managed care

Six insurers will split $20 billion to manage Medicaid for Ohio, according to Becker’s Hospital Review’s April 13 story.

A massive arrangement has been reached between Ohio and six insurance companies hired to coordinate Medicaid managed insurance for more than 3 million low-income and/or disabled state citizens. It’s set to go into effect in early 2022.

You may notice that Centene is conspicuously absent from the list. After all, it had been contracted by Ohio to manage its Medicaid program. But given that Centene was sued in March by Ohio’s Attorney General Dave Yost for allegedly defrauding that program of millions, it would be a little tough for them to make the cut here. Ohio’s suit against Centene centers on allegations of the company massively overcharging on its Medicaid contract through pharmacy benefit managers (PBMs).

So, who are the lucky winners who’ll take home a piece of this $20 billion pie? Let’s look at the list:

• AmeriHealth Caritas Ohio
• Anthem Blue Cross and Blue Shield
• CareSource Ohio
• Humana Health Plan of Ohio
• Molina Healthcare of Ohio
• UnitedHealthcare Community Plan of Ohio

Can we expect these six new insurers to operate on the up and up, especially as they use their own PBMs more and more? When one apple goes bad, it’s hard to trust the rest of the bunch. Maybe we’re standing too close to Centene—we just got a chill.

Original Article:

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