Ohio Medicaid changed the way it processes claims for payments from health providers a few years ago. And now it appears it's taking longer for those providers to get paid.
Although the agency denies it's a problem, two large central Ohio hospital systems confirm they've experienced the delays. And a Kasich-era expert says he thinks he knows what's happening.
Earlier this month, an Ohio Department of Medicaid program manager said the problem is "severe" at an open meeting of a state advisory group.
The Ohio Department of Medicaid now says the program manager was wrong.
But Ohio State University's Medical Center and Nationwide Children's Hospital confirm they've experienced the problems.
The expert, Greg Moody, was the director in the Office of Health Transformation under former Ohio Gov. John Kasich and oversaw the expansion of Ohio Medicaid. Moody told state lawmakers last week at a meeting of the Joint Medicaid Oversight Committee, what he thought happened to what was once one of the fastest systems in the country.
"Prior to 2022, providers would submit a claim to the health plans. The health plans would pay the claim, and Ohio had a reputation for being a very fast payer," Moody said. "It was usually seven, 14 days, something like that. And then that information would be shared with the Medicaid department that would verify it, reconcile it, look at the data for policy reasons, and that's how the system worked."
But the process changed when state officials brought in a contractor, Gainwell Technologies.
"In 2022, what Medicaid essentially did was reverse the workflow," Moody said. "So now, providers submit their claims to the department, to the fiscal intermediary. The fiscal intermediary then processes that claim and then sends it over to the health plans to pay."
Moody said the "delays are related to getting it through the fiscal intermediary to the plan."
Moody also said lawmakers should have Ohio Medicaid report the time it takes for claims to be paid out.
Ohio Medicaid Director Maureen Corcoran has refused an interview with WOSU, and left several of our questions unanswered.
WOSU is pursuing public records about the problem.
Stephanie O'Grady, a spokesperson for Ohio Medicaid, said in an email that Alison Barr, a program manager who spoke about the problem at a meeting of a doula advisory group, wasn't supposed to talk about the IT systems, and called her comments "inaccurate."
"Medicaid’s systems are processing claims appropriately. Medicaid has an accessible process for addressing any claims, processing errors or questions and will continue to monitor for any issues. When an issue does arise, a team is assembled to address the specific needs of a provider, providers are notified and the issue is resolved," O'Grady said via email.
Barr was answering questions at the meeting earlier this month about why some doula providers haven't been paid. Barr told the room the IT issues have been "severe," making a huge impact on hospital systems and requiring manual interventions to correct.
Ohio State University's Medical Center confirmed the problem.
"We have had and continue to experience claim issues since the system went live two years ago. Ohio Medicaid has since waived the 12-month filing limit, acknowledging the delays in fixing issues," a spokesperson stated in an email.
A Nationwide Children's Hospital spokesperson also confirmed the issue.
