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ODM Reports on Eligibility Backlog at Monthly Meeting

At its September meeting with the Ohio Department of Medicaid, representatives from ODM reported that the Medicaid pending numbers had shrunk to 20,000 pending cases beyond 45 days, down from nearly quadruple that number one year ago. The state has stepped in with counties with significant backlog, offering 1:1 support for very-long cases and approving overtime payments for county workers. To date, ODM’s efforts have been focused on initial applications rather than renewals, and began with focusing on the longest cases first. Currently, ODM has more than 250 pending cases beyond 180 days, and once those cases are cleared, it will move to those that are at 120 days.

ODM has also been offering technical support to counties to ensure the systems that provide data on outstanding cases to ODM and the counties are showing the same results.

LeadingAge Ohio has been active in advocating solutions related to Ohio’s backlog in Medicaid eligibility over the past two years, and asks members to reach out to Susan Wallace, Director of Government Relations and Public Affairs at to share whether they’ve seen improvements in longstanding pending cases, as well as particularly challenging cases to be forwarded to ODM. LeadingAge Ohio also encourages members to use the reports available via the MITS system to identify those residents who are approaching renewal.

Other Medicaid updates included:

  • An individual’s QMB designation is currently not showing up in MITS, as of several weeks ago. ODM is following up on this concern to ascertain whether it is related to a recent programming update.
  • ODM will be setting up a workgroup to track the process for disenrollment from managed care, when a resident is transitioning to long-term care.
  • ODM continues to work on its level of care (LOC) rules. One key change is that ODM will be moving away from the assessment tools originally developed by Carestar and to tools housed within the Department of Aging. At this point no timelines are available, but ODM continues to make progress.
  • In August, LeadingAge Ohio joined other stakeholders in a meeting to discuss the revision of the PASRR rules, and that feedback is still being incorporated. Topics discussed included the challenges of moving to HENS, concerns around the accuracy of PASRR information, among others.
  • ODM shared that MyCare Ohio plans have been instructed to pay nursing home room and board for hospice patients through October 15, regardless of whether there was prior authorization or if there is a contract established between hospices and plans. Beginning on October 16, hospices should have established a contract which will include prior authorization requirements.
  • ODM shared that providers participating in the ventilator program must complete and submit reports, or be at risk of being terminated from the program.
  • ODM confirmed that it did not plan to use the Optional State Assessment when Medicare transitions to the Patient-driven Payment Model (PDPM) payment system on October 1.  ODM is working towards assigning a contractor to advise on the future plan for Medicaid payment, including whether ODM will continue to rely on RUGS IV or transition to PDPM. ODM noted that it added one item to Section S of the MDS, to track payor source.
  • ODM continues to struggle with the issue patient liability, and has an upcoming call with the Centers for Medicare & Medicaid Services to evaluate whether there is a different approach it could be taking.
  • ODM continues to get calls because providers have failed to complete their discharge in Provider Gateway, which means that an admitting provider is unable to complete the admission. ODM is considering allowing an auto-discharge option, to ensure downstream providers are not affected.

LeadingAge Ohio meets with the Department of Medicaid on a monthly basis to discussing outstanding issues and updates. Topics and questions for ODM may be sent to Susan Wallace at for inclusion in the October meeting agenda.  

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Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.