The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
After refusing to disclose federal watchdog reports, the Ohio Department of Medicaid last week claimed that the relevant information it “makes available to the public appears to include at least as much, if not more information.”
It pointed to some of that information Monday, but it’s hard to evaluate whether it meets or exceeds that released in other states’ reports. And the department again declined to give specific examples of the kinds of information in the reports that are trade secrets.
The actions raise questions about the department’s openness and its efforts to police its contractors.
At issue are reports that the department’s billion-dollar contractors are required to file. Known as “medical-loss ratio” reports, they’re meant to ensure that managed-care contractors aren’t excessively profiting off of taxpayer dollars meant to provide health care to the poor and disabled.
The Ohio Medicaid department, which frequently brags about its claimed transparency, was asked in a December open-records request for copies of the federally required reports. Three months later, the department responded by saying it wouldn’t release the reports because the contractors they’re meant to keep tabs on said they contain trade secrets.
The Medicaid Department — a $35 billion a year agency — did release report summaries for 2019, more than two years ago.
They showed in percentage terms what each of the agency’s five managed-care contractors spent on health care and how much they kept in the form of profit and administrative costs. But the summaries didn’t show the underlying data.
The refusal to release those data raised eyebrows among some who follow the arcane, massive-spending world of Medicaid.
“Withholding these routine, mandatory Medicaid (managed-care organization medical-loss ratio) reports is mystifying,” tweeted Kip Piper, a former director of the Wisconsin Medicaid department and former senior advisor to the administrator of the Centers for Medicare and Medicaid Services, the federal agency in charge of the programs. “This is not trade secret or proprietary data. Odd, troubling, ill-advised decision, frankly.“
In an interview last week, Piper explained that in turning over the management of care to private companies, governments want them to find efficiencies without being too prescriptive. The MLR reports are meant to act as guardrails to ensure that the vast bulk of the money is being used to pay for health care, he said.
“The importance of the medical-loss ratio is it’s a backstop for the (managed-care) plans,” Piper said. “You don’t want to micromanage how you get from A to B, you want to sit down and agree on what B is.”
Also raising questions about Ohio Medicaid’s claim that the medical-loss ratio — or MLR — reports amount to trade secrets is the fact that some other states post the reports on their websites.
Medicaid spokeswoman Lisa Lawless was asked last week why her department considered the reports to contain trade secrets while states such as Arizona do not.
“Ohio makes detailed MLR information available and the data we publish likely exceeds the information made available by most other states,” she said in an email Friday. “MLRs are calculated in different ways from state to state and relative to the federal (Centers for Medicare and Medicaid Services) submission. As one example, expenditures related to quality improvement activities are a common difference, variably defined from state to state and sometimes included, sometimes not.”
Lawless didn’t explain, however, how such differences in reporting related to trade secrets or the public’s right to know how its billions are being spent.
Nor has she named any of the kinds of data in the Ohio MLR reports that would amount to trade secrets — information that would give competitors of a managed-care organization an unfair advantage if they knew it. Piper, the Medicaid expert, said the kinds of data the federal government requires for the reports are aggregate and thus unlikely to be specific enough to be considered proprietary.
Lawless added that even though her department won’t turn over its MLR reports, it’s making more information public than some that do.
“Based on a preliminary review of the Arizona reports, the MLR information that ODM makes available to the public appears to include at least as much, if not more information,” she said.
Pressed on the matter, she pointed to Medicaid managed-care “dashboards.” One is the financial dashboard for calendar year 2020. It shows medical, administrative and other expenses for each of the state’s five managed-care plans. But the information doesn’t appear to be as granular as in this MLR report of an Arizona Medicaid managed-care plan.
There are reasons to believe that the federal agency in charge of Medicaid intends for the MLR reports to be public. The Medicaid and CHIP Payment and Access Commission, a non-partisan congressional agency, addressed the issue in a January issue brief. It said that the reports are “intended to allow comparisons of plan performance among the major health care programs and across states.”
Further supporting the idea that MLR reports are intended for public consumption, the congressional brief adds, “… due to delays in developing standardized reporting templates, 2022 will be the first year that states are required to submit these reports to CMS and publish them.”
Both statements imply that the federal government intends the reports to be shared with the public, and Lawless said her department is preparing to submit this year’s MLR reports using the new, standard federal template.