Medicaid director backpedals on possibility of cutting drug coverage, expansion population

The director of the Ohio Department of Medicaid, it appears, is at least partially backtracking after telling a state panel that ending Ohio’s expanded eligibility for the program and eliminating prescription drug coverage are possible options to fill a looming state budget gap.

On Monday, Director Maureen Corcoran made a presentation to the Ohio Prescription Drug and Affordability Advisory Council. 

It included a slide that addressed the possibility of a $2.4 billion deficit for the budget year that starts July 1. As part of a list of possible cost-containment options was “Eliminate optional services, e.g. pharmacy” and “Eliminate optional covered groups.”

Since taking her job early last year, Corcoran has had a sometimes-contentious relationship with Ohio pharmacists. The community pharmacists are frustrated with how slow the agency has been to fix the system for paying for Medicaid drugs and with delays getting them a supplemental payment approved last year by the legislature.

Raising the possibility of eliminating Medicaid prescription-drug coverage got the attention of at least some pharmacists.

“We think it’s a power play to scare people into accepting the terrible reimbursements we’re getting,” Lynne Fruth, who owns a chain of pharmacies in Southeastern Ohio, West Virginia and Kentucky, said in a text message. “So what are they going to do? Give people a doctor’s appointment and no medicine?”

In an email, Corcoran clarified why she included the items in her presentation to the council.

“The list at the bottom of slide 18 in my presentation is a listing of the various types of decisions or choices that any Medicaid program has at its disposal to reduce costs,” she said. “So, consider this to be a generic list of the tools available for cutting or reducing a Medicaid budget.”

But then Corocoran acknowledged placing on the list of potential cuts at least one item that the state is barred from making.

“However, also notice that at the top of the list it says, ‘Cost containment options (or not),’” she said. “This is an acknowledgment that, during our current pandemic, some of these options will not be available to us because of federal requirements. Specifically, eliminating or terminating coverage for individuals during the pandemic is not allowed.”

When Congress in April agreed to pick up an additional 6.2% of the cost of Medicaid, it mandated that states not ratchet down eligibility requirements. That means continuing to cover hundreds of thousands of Ohioans bailed in under the 2014 Medicaid expansion.

Corcoran also said that she included the agency’s $2.5 billion in annual drug spending as a possible cut only for educational purposes. She didn’t explain why “pharmacy” was the only item on the list in boldface.

According to federal rules, it’s optional for Medicaid to cover prescriptions, but every state does.

“This is simply to educate the audience that pharmacy is considered an optional service under the Medicaid state plan,” Corcoran said.

Antonio Ciaccia of the Ohio Pharmacists Association said he thinks it’s unlikely that Ohio Medicaid would cut prescription drug coverage during a pandemic.

“Director Corcoran has said that Medicaid’s primary focus has been on the patient experience,” he said in an email. “I trust that (Ohio Department of Medicaid) leadership would seek out other solutions like pushing for an increase in the (share of Medicaid paid by the federal government), curbing (pharmacy benefit manager) overpayments for specialty drugs, or tapping the rainy day fund before making a move that would result in a massive increase in poor Ohioans going without needed medications.”