The Ohio Senate Medicaid Committee convened on April 29, 2025, to discuss critical updates regarding program integrity, transparency, and the ongoing evolution of Medicaid services in the state. The meeting focused on several key agenda items aimed at enhancing compliance and leveraging data to improve service delivery.

The session began with an emphasis on the importance of transparency within the Medicaid system. Officials highlighted recent changes involving pharmacy benefit managers (PBMs) and fiscal intermediaries, which are designed to ensure fair compensation for pharmacies and eliminate hidden financial transactions. This initiative aims to provide a clearer view of drug costs for Ohio Medicaid recipients.

A significant portion of the discussion centered around the "unwinding" process, which refers to the reevaluation of Medicaid eligibility following the pandemic. Officials noted that this process has yielded valuable insights into data usage, which will be leveraged to enhance the assessment of new applicants and those undergoing reassessment. A chart detailing various data sources used for eligibility checks was referenced, illustrating the comprehensive approach taken to ensure accurate assessments.

The committee also addressed the implementation of electronic visit verification (EVV) for home and community-based services, a requirement from the Centers for Medicare & Medicaid Services (CMS). While providers have been trained and have access to data regarding their claims, the meeting marked a transition to actively denying claims that do not meet EVV standards, reinforcing accountability in service delivery.

Additionally, the committee discussed ongoing legislative requirements, including a report on direct care wages for individuals served under Medicaid waivers, which is a collaborative effort involving multiple state departments.

Finally, the meeting acknowledged the substantial size of the Medicaid budget and the growing concerns surrounding federal policy changes and economic uncertainties. Officials expressed their commitment to navigating these challenges while ensuring the sustainability and integrity of Ohio's Medicaid program.

In conclusion, the Ohio Senate Medicaid Committee's discussions underscored a proactive approach to enhancing transparency, leveraging data, and ensuring compliance within the Medicaid system, all while addressing the complexities of budgetary and policy challenges ahead.