When Governor DeWine took office in January of 2019, we began to see the platforms he campaigned upon, including his Opportunity for Every Ohio Kid agenda, begin to take form as his administration settled in and our state FY20-21 budget deliberations ensued in March. Among the new administration’s varied priorities, immediate attention was placed on early childhood development as the state was also putting the state’s five Medicaid managed care plans out for new bids.  In a thoughtful effort to marry these two priorities, Groundwork Ohio, the state’s early childhood advocacy organization advancing early learning and healthy development strategies in the prenatal-five period, also took immediate action. We used our relationships to work with the cross-agency early childhood team and sought to influence the managed care procurement process to advance a vision for young children.

The lengthy process of managed care procurement began in February of 2019. This is the first time since 2011-2012 that the state has bid out contracts for plans, which oversee the administration of benefits for most of the state’s Medicaid enrollees, including nearly half of Ohio’s 2.5 million children.  There has been a clear interest from the Medicaid agency leadership to have an open discussion with stakeholders to explore innovative ways to improve the quality of health care and health outcomes. In June of 2019 the Department released a request for information (RFI) to gather public input to inform the process of selecting new managed care partners. This first step was to collect feedback on current Medicaid services, what is working and ideas for improvement.

Groundwork Ohio, with input from key coalition partners, submitted a response to the RFI that focused on the role of Medicaid managed care in doing the following:

• Advancing early childhood development and meeting the needs of Ohio’s youngest children and families
• Providing a proactive response to the decrease in coverage rates for children
• Prioritizing the social and emotional development of young children
• Advancing child health equity through data, evaluation and accountability
• Improving Ohio’s evidence-based home visiting system

During this procurement period, we have taken any and all requests to meet with plans currently operating or interested in doing business in Ohio to better understand their thinking as it concerns young children. Given the Governor’s focus on children and our organization’s track record advocating for young children, it was natural for plans to seek out our thinking on how to be competitive in Ohio’s market.  We hope that we have challenged and complemented their thinking while building relationships with prospective partners willing to innovate and experiment with us as we continue to explore ways in which Medicaid can better serve the state’s young children, including full integration into Ohio’s early childhood system.

As feedback has continued to be considered since June, there is currently no deadline to submit responses to the RFI.  Accordingly, as we have continued to engage stakeholders on the process, we took the opportunity to reflect on our initial submission and work with a focused team of state and national experts, including Georgetown University CCF in September to revisit our thinking and provide an addendum response that communicates a concrete framework for the ways we envision Ohio’s Medicaid managed care reforms could be leveraged to advance a quality agenda for Ohio’s youngest children. This framework sought to address the following key questions:

• What is the role of managed care organizations in advancing a kid’s quality agenda?
• What is the role of community-based organizations in advancing a kid’s quality agenda and how might they work with managed care organizations?
• When bidding on a state contract, what questions would we ask of the managed care plans to evaluate their commitment and experience with young children and their families?
• What are the priorities, goals, metrics and bundle of services that we should hold managed care plans accountable to when advancing a quality agenda for Ohio’s youngest children?

As we approach the holidays and a new year, we continue to invest in relationships with our stakeholders inside and outside of state government as we await the competitive procurement process to unfold.  Additionally, we continue to include the role of Medicaid in our published work outside of the RFI response including our recent Advancing Early Childhood Mental Health Through Evidence-Based Home Visiting report.  State child advocates have an important role to play in influencing Medicaid managed care efforts in their states when opportunities arise. Given the incredible federal and state resources available to children through Medicaid, we can’t afford to overlook children’s needs during the procurement conversation.  While unpacking the nuances of managed care procurement can seem daunting on the surface, we encourage other groups to join us in trying to put children front and center in Medicaid business decisions.  Informed by the wisdom and expertise of Georgetown University CCF and other national partners, together we can make Medicaid work even better for kids.