Ruling allows Ohio to dole out Medicaid services
Ohio is prepared to move forward with certain Medicaid contracts after a court ruled in the state’s favor in a dispute over how the contracts were awarded.
Amerigroup, a company that claimed it was improperly denied a contract under what it said was a flawed process, had sued the state’s Department of Job and Family Services alleging abuse of discretion in how the state scored applications.
The companies awarded contracts will provide health care services to more than 1.6 million poor and disabled people, more than two-thirds of Ohio’s Medicaid population. The remaining Medicaid beneficiaries receive care under a fee-for-service model, in which doctors are reimbursed for each service through provider agreements with Ohio Medicaid.
Virginia Beach, Va.-based Amerigroup was not among the top five scorers that were preliminarily awarded the state contracts in June. The insurer currently has a contract in Ohio’s Medicaid managed-care program and has been providing services to the state’s beneficiaries since 2005. It’s expected to lose business with the state’s switch to new plans.
In a 2-1 ruling, the Franklin County Court of Appeals on Friday affirmed a lower court’s decision, saying Amerigroup failed to prove the state abused its discretion in awarding the contracts.
“Differences of interpretation, or even simple mistakes by ODJFS are not an abuse of discretion,” the appellate court said.
The dissenting judge was Judith French, who was recently appointed to the Ohio Supreme Court.
An Amerigroup spokeswoman said Wednesday the insurer was disappointed with the decision and exploring its legal options. The company still could appeal the ruling to the state’s highest court.
“Amerigroup will continue to coordinate the care needs for and provide quality services and support to our 61,000 members in Ohio,” said Maureen McDonnell, the company’s vice president of public affairs.
Amerigroup’s challenge had blocked state officials from signing agreements with the five health plans that were the highest scorers. Those insurers are: CareSource; Paramount Advantage; United Healthcare Community Plan of Ohio; Molina Healthcare of Ohio Inc.; and Buckeye Community Health Plan.