Joint Medicaid Oversight Committee (JMOC) Chairman Sen. Dave Burke (R-Marysville) told Hannah News Thursday that he believes the "band" between the lower and upper estimates for Medicaid growth in the 2020-21 biennium to be "reasonable."

Those ranges, which include a legislatively passed increase in nursing home reimbursement that will come in at 2.8 percent for the next biennium, are a 2.9 percent increase at the lower end to a 4.5 percent increase at the upper end in the projected growth in the "per member per month" (PMPM) cost for Medicaid recipients over the next two fiscal years.

This is based on the projected PMPM cost of $657 to $675 in FY20 and $677 to $707 in FY21.

According to the Revised Code, JMOC is to identify its own estimates for medical inflation for the upcoming biennium -- apart from the estimates developed by the Ohio Department of Medicaid (ODM) and Office of Budget and Management (OBM). JMOC then submits its findings and report to the governor and General Assembly with the Medicaid director required to limit the program's growth to JMOC's recommended PMPM level or to a three-year average of the CPI rate for medical services.

JMOC will vote on its recommendation at its December meeting. It has historically selected a target somewhere between the two ranges, Burke commented.

This is the fourth time JMOC has gone through this process, and Burke is pleased to see how the process is working to "bend the arc of Medicaid spending." Author of the legislation creating JMOC, he said the point was not to create a process to cut Medicaid but rather "control what we can" and contain the rate of growth while still providing health care to poor Ohioans. He said a biennium is but one step in the process as they take incremental steps over time.

Burke added, "Look what we've done. Before we had double digit growth and we are now helping more individuals while keeping a low rate of growth."

The point, he stressed, is to focus on state spending and areas where the state has control.

Before representatives of Optumas, the JMOC's actuarial firm, presented its findings at Thursday's meeting, Susan Ackerman, JMOC executive director, presented a current overview of the Medicaid program, showing that since June 2017, the caseload has been dropping. But, she stressed, the Medicaid population is made up of several groups, whose health care costs are not the same. "This mix affects the state share of the program," she said, and, as it is the cheaper individuals -- younger adults including those in "Group 8," the Medicaid expansion population -- PMPM will increase because it is the sicker, more expensive individuals who remain on the program.

Burke referenced this "paradox" in his closing remarks, noting, "We have done our job on the economy so well, we are losing our cheaper people."

Also contributing to the projected growth in the next biennium is the 2.8 percent in nursing home payments, costing, according to Optumas' actuary Barry Jordan, $97 million in SFY20 and $196 million in SFY21 for a $293 million biennial total.

That is why, Ackerman stressed, the mix of Medicaid recipients matters. That population mix includes adults, children, disabled, dual-eligibles and "others."

Also coming into play in the estimated growth for the next biennium is the cost of prescription drugs. Optumas identified the "nervous system (except autonomic)" and the "electrolyte balancing system/metabolic and system/nutrition" therapeutic classes of drugs as the ones with the largest growth. The "nervous system" includes drugs such as anti-psychotics and anti-convulsants, while the "electrolyte balancing" drugs include insulin -- which is seeing a rapid increase in price.

Questions from committee members included the following:

- From Rep. Stephen Huffman (R-Tipp City): Why not just go with the Midwestern CPI projected rate which is 2.5 percent? Ackerman responded that the CPI measures different elements and is not the most direct measure of the program.

- From Sen. Lou Terhar (R-Cincinnati): How does this process incorporate outside trends that affect the budget? Ackerman said that is done by OBM and governor as they look to developing the biennial budget. The Legislative Service Commission also provides legislators with this information.

- Sen. Charleta Tavares (D-Columbus) asked what other states with nursing home reimbursement. The Optumas representatives said they would provide that information.

- Rep. Emilia Sykes (D-Akron) asked why Group 8 individuals were not broken out as a separate category, given all the attention JMOC has provided them. Ackerman said they "were not a lot different from the CFC population. … The cost profile is the same."

Other questions related to lessening the use of nursing home care, drivers for the drug costs, and the impact of moving behavior health into Medicaid managed care.

The PowerPoint presentation can be found on the Hannah News homepage at www.hannah.com >Important Documents and Notices>Library.