Centene back in good graces of Ohio Medicaid after $88M settlement - The Columbus Dispatch

An $88.3 million settlement with Ohio has won a health-care company a piece of the state's largest contract in history.

Buckeye Health Plan — a subsidiary of Centene, a $111 billion corporation and the largest Medicaid managed-care organization in the country — was added Friday to six firms already awarded shares of the $20 billion deal.

Ohio uses private managed-care companies to handle virtually all aspects of the $3 billion Medicaid program, which provides health-care coverage for poor and disabled people. More than one in four Ohioans currently receives Medicaid benefits, including about 1.3 million children.

Ohio Medicaid originally deferred its decision on Buckeye's proposal after Ohio Attorney General Dave Yost sued Centene and related entities, saying the companies defrauded Ohioans of millions.

After vigorously opposing the lawsuit initially, Centene later agreed to the $88 million settlement with Ohio in June and set aside more than $1.1 billion to resolve claims with other states. The company does not admit fault in any of the deals, which are centered on its pharmacy benefit manager subsidiary, Envolve Pharmacy Solutions.

The Medicaid department characterized the inclusion of Centene/Buckeye as Ohioans now having "more options when choosing a managed-care health plan in the department's new person-centered vision of care." 

Already awarded managed care contracts:

• UnitedHealthcare Community Plan of Ohio

• Humana Health Plan of Ohio

• Molina Healthcare of Ohio

• AmeriHealth Caritas Ohio

• Anthem Blue Cross and Blue Shield

• CareSource Ohio

Another company that challenged the Medicaid department's contracting process, Paramount Advantage, a subsidiary of Toledo-based Pro-Medica, remains excluded from the list. It was the only company already providing managed-care services for Ohio Medicaid that was denied a portion of the new contract, which will take effect in early 2022.

Gov. Mike DeWine ordered the new round of contracts shortly after he took office in 2019 in response to a "rip-off" of taxpayers by pharmacy benefit managers and the inability of the managed care organizations that hired them to bring them under control.

During a news conference to announce the settlement, reportedly the second-biggest in Ohio, Yost said, "I hope that a message is going out to the entire industry across the country that the days of operating behind the curtain as the Great Oz are over, and you're working for the people of these states that hired you."

dowland@dispatch.com

@darreldrowland