Ohio Medicaid says it’s more transparent than other states

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After refusing to release federal surveillance reports, the Ohio Department of Medicaid claimed last week that relevant information “makes available to the public seems to contain at least as much, if not more, information.

He highlighted some of that information on Monday, but it’s hard to gauge whether it matches or exceeds that published in other states’ reports. And the department again declined to give specific examples of the kinds of information in the reports that are trade secrets.

Actions raise questions about ministry’s openness and efforts police its subcontractors.

These are reports that the department’s billion-dollar contractors are required to file. Known as “medical loss ratio” reports, they aim to ensure that managed care providers do not profit excessively from taxpayers’ money intended to provide health care to the poor and disabled.

The Ohio Medicaid Department, which frequently boasts of its claimed transparency, was asked in an open records request in December for copies of reports required by the federal government. Three months later, the department responded by saying he would not publish the reports because the contractors they are supposed to monitor say they contain trade secrets.

The Medicaid department — a $35 billion a year agency – published summaries of reports for 2019, more than two years ago.

They showed in percentage terms what each of the agency’s five managed care contractors spent on health care and how much they kept in profit and administrative costs. But the summaries did not show the underlying data.

The refusal to release this data has raised eyebrows among those who follow the dark and spendthrift world of Medicaid.

“Withholding these routine and mandatory Medicaid reports (medical loss reporting for managed care organizations) is mystifying,” tweeted Kip Piper, former director of the Wisconsin Medicaid department and former senior administrator adviser to the Centers for Medicare and Medicaid Services, the federal agency in charge of the programs. “It’s not about trade secrets or proprietary data. Weird, disturbing and ill-advised decision, frankly.

In an interview last week, Piper explained that by handing over managed care to private companies, governments want them to find efficiencies without being overly prescriptive. The MLR reports are meant to act as safeguards to ensure that most of the money is used to pay for health care, he said.

“The significance of the medical loss ratio is that it’s a safety net for (managed care) plans,” Piper said. “You don’t want to micromanage how you get from A to B, you want to sit down and agree on what B is.”

The fact that some other states publish the reports on their websites.

Medicaid spokeswoman Lisa Lawless was asked last week why her department considered the reports to contain trade secrets, unlike states like Arizona.

“Ohio makes detailed MLR information available, and the data we publish likely exceeds the information made available by most other states,” she said in an email Friday. “MLRs are calculated in different ways from state to state and relative to federal submission (Centers for Medicare and Medicaid Services). For example, spending on quality improvement activities is a common difference, defined variably from state to state and sometimes included, sometimes not.

Lawless did not explain, however, how these differences in reporting relate to trade secrets or the public’s right to know how his billions are spent.

She also did not name any of the types of data in the Ohio MLR reports that would amount to trade secrets — information that would give a managed care organization’s competitors an unfair advantage if they knew about it. Piper, the Medicaid expert, said the types of data the federal government needs for reporting are aggregated and therefore unlikely to be specific enough to be considered proprietary.

Lawless added that while his department won’t hand over its MLR reports, it makes more information public than some that do.

“Based on a preliminary review of the Arizona reports, the MLR information that the ODM makes publicly available appears to include at least as much, if not more, information,” she said.

Pressed on the subject, she pointed to Medicaid’s managed care “dashboards.” One is the financial dashboard for calendar year 2020. It shows medical, administrative, and other expenses for each of the state’s five managed care plans. But the information doesn’t seem as detailed as in this MLR report from an Arizona Medicaid managed care plan.

There is reason to believe that the federal agency in charge of Medicaid intends to make the MLR reports public. The Medicaid and CHIP Payment and Access Commission, a nonpartisan agency of Congress, addressed the issue in January information note. He said the reports are “intended to allow comparisons of plan performance between major health care programs and between states.”

Further supporting the idea that MLR reports are intended for public consumption, the Congressional brief adds: “… due to delays in developing standardized reporting templates, 2022 will be the first year that States will be required to submit these reports to CMS and publish them.

Both statements imply that the federal government intends to share the reports with the public, and Lawless said his department is preparing to submit this year’s MLR reports using the new standard federal template.

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