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On the eve of a deadline for a new congressional map, majority Republicans strike a deal with Democrats.

The state puts money toward food assistance as the federal shutdown drags on.

And an exit interview with the departing state Medicaid director.

That's this weekend.

The state of Ohio.

Welcome to the state of Ohio.

I'm Karen Kasler.

Republicans and Democrats on the Ohio redistricting commission came to a deal on a bipartisan 15 district congressional map.

Right on the deadline.

The panel's two Democrats voted for the map on Friday, after agreeing on Wednesday night for a map that could give the GOP 12 seats to the Democrats three.

Right now, the congressional delegation is ten Republicans and five Democrats.

The new map, unveiled Thursday appears to tip the Toledo and Cincinnati area districts, now represented by Democrats Marcy Kaptur and Greg Landsman, further toward the GOP.

While strengthening the Akron area districts now represented by Amelia Sykes.

Four Democrats.

Activists angry over the deal testified at both meetings and were not pleased with the response.

The fact that they didn't ask any questions.

And the fact that they were so quiet shows that really, this was just performative.

I'm disappointed because I thought that there would be more of an opportunity to not just jam through a map at night and not really hold firm with both parties to have the citizens actually see the map, have a chance to dissect it, and if it had to go to the next step, it had to go the next step.

The tension continued after the meeting.

Republican Co-Chair Representative Brian Stewart defended the process as constitutional and the map as a good compromise, though he said there was no way to make everyone happy.

And he singled out people who have repeatedly testified at redistricting commission meetings over the years.

there's always a lot of paid activists in this room when you're talking about redistricting.

There's always a lot of folks in the same t shirts meeting after meeting, and the same 24 people, the same 24 people are always going to be upset about redistricting.

They want to he wants to get some.

The Democrats could win and they're going to be disappointed by that.

We have 11.8 million people in this state who voted for a process that has worked, that has been carried out to the letter, has resulted in a bipartisan compromise.

And I think most people who are not paid activists are going to be pleased with the result.

I know I am not a paid activist, the panel's two Democrats.

House Minority Leader Danny Isaacson and Senate Minority Leader Nikki Antonio said the process needs to be fixed again, but this map was the best option at the deadline.

we're down to the clock to the end of the 11th hour.

Looking at a map, trying to make a decision on what's the best way forward for our congressional districts, trying to give a fair voice to the to the people of the state of Ohio in a system that works for politicians picking their, people instead of the people, picking their politicians.

And so we are committed to trying to find fairness for the people of Ohio.

But this system that we have in the long run is probably me going to need a fix to be fixed again.

But today we have to look at, the best way to go forward with our congressional maps, because we are required to do that.

This suggests Democrats fear going back to the legislature where a Republican map could pass in November without any Democratic votes.

The deal scuttles a possibility of a referendum to repeal the map.

But there were conservatives who were also frustrated with the map sharing on social media that they felt Republicans could have driven a harder bargain and gotten more seats.

As of this weekend, low income Americans who receive Supplemental Nutrition Assistance Program or Snap benefits are finding out how to get along without them.

As the federal government shutdown goes on, that includes 1.4 million Ohioans who received $264 million in Snap benefits each month.

On Thursday, governor Mike DeWine signed an executive order directing the Department of Job and Family Services to give $7 million to food banks and $18 million to those in the Ohio Works First program for low income families with kids, effectively doubling the monthly benefit for more than 63,000 Ohioans, including over 57,000 children.

We really want to focus, in two areas.

One is on the poorest of the poor, about 57,000 children.

So we have targeted those those families with those 57,000 children with additional funds that they will they will get and they will get that every week as long as this list goes on.

The second thing was, of course, to target our food banks.

We know that they can get food out quickly.

And so those are the two things that we came up with, that we could actually get done and get done right away.

And where we actually did have money, that we could, could spend on that.

So, this is not a substitute for snap.

Not every family is going to get additional funds, but we want to target specifically those families where we thought that they really, desperately would need the money and would need the help.

The money comes from unspent federal temporary aid to Needy Families funds.

Democratic lawmakers have called for the state to use some of the record $4 billion in state rainy day funds to supplement those not receiving their Snap benefits.

But DeWine's office said there was no way to directly fund Snap, since it's a federal program and legislative action would be required to use money in the rainy day fund.

As of Friday, the office of the agency that runs the single largest state program and accounts for about 5% of the state's economy, is vacant.

Ohio Medicaid Director Maureen Corcoran announced her resignation a few weeks ago.

She has both a nursing degree and an MBA, and joined governor Mike DeWine administration after serving in several health policy related positions, including as interim Medicaid director under Democratic former Governor Ted Strickland.

On her last week in office.

Corcoran sat down with me to talk about why she took the job and what she did in it.

Ohio Medicaid director is arguably one of the toughest jobs in state government.

I mean, you're managing an agency that runs the single largest state program and accounts for about 5% of the state's economy.

So what made you want to take this job when you got the call from governor DeWine?

Well, I I've been attracted to or involved in Medicaid now for more than 40 years.

Virtually all of my professional adult career.

And I think what I really enjoy about it is, you know, I'm a nurse by training.

And so my focus is really on how do we improve care for people.

But at the same time, how do we bring the financial dynamics into the equation so that we're helping providers not only have a sustainable business model, but be encouraged and incentivized to change and adapt to what individual consumers need.

So I and almost everybody I work with in the department, our kind of problem solvers, let's figure out a new way to do things, find an innovative approach.

And that's what I really enjoy about it.

You were interim Medicaid director under former Governor Ted Strickland.

Did things change between then and now?

I imagine they did quite significantly.

Well, it depends on your perspective.

As I look back, there is a, you know, an arc of policy change that occurs in Medicaid all the time.

You know, adapting to the economy, to the things that are important in a state, to the leaders and to, you know, to individual consumers.

And so I think that's one thing that I advantage I had is that I didn't have a set expectation because I knew that there would be, you know, an arc of change that would be a constant.

One of the changes that had happened in the previous administration under former Governor John Kasich, was the creation of this Office of Health Transformation.

When you took office, you issued a memo that described what your agency was facing from all that, describing what you inherited as a mess and that Ohio could face fines if things weren't fixed.

We're talking about payment error rates, which you said were above the national average.

Gaps in oversight, unaddressed caseload backlogs, defects in information technology, among other things.

Do you leave with those things fixed and things in a better place?

Yes.

In fact, this morning we were on the phone with one of the assistant directors of the federal CMC's, the portion of Medicaid of CMS that handles Medicaid.

And she was commenting on my leaving, and she went on at some length about how impressed she was with how Ohio responded to all of that, jumped right in, made changes and changes in a way that then positioned us very well for the pandemic and the unwinding.

So not just kind of putting a Band-Aid, but how do we find a new way that's better?

Which is kind of the the framework or the orientation of all the folks that I work with.

And she, was just really, clear about how significant a leader Ohio is.

She said what she notices about us, about Ohio is just how thoughtful the people within our department are, and that they often look to us for, which is why we were on the phone with her.

Look to us for how we're thinking about work requirements.

And how are we thinking about, you know, the changes in eligibility and some of those things.

Earlier this year, the former director of that Office of Health Transformation, Greg Moody, told the Joint Medicaid Oversight Committee that delays in payments to Medicaid providers were severe.

He blamed a contractor that had been brought in by Medicaid.

You told me when you were here in March that this has been a massive undertaking, and you've seen dramatic improvements.

Was the criticism of that warranted?

Is this all been fixed?

We implemented, an entire new Medicaid enterprise system.

Excuse me.

We we implemented an entire Medicaid enterprise system.

We went through a dozen procurements.

We, it is massive.

It is just massive.

Every IT system and implementation has challenges, and we certainly did have ours.

However.

However, we had developed a way of tracking information that we could.

We knew exactly which providers were having trouble, exactly how much they were short.

In other words, we had taken what we had learned from challenges in the past and and developed a way of being proactive in doing that.

So the the challenges as they were described were, much presented as much more severe than what in practical reality occurred.

However, you know, we did and do continue to work very hard to make sure that every single provider who's having trouble has somebody to talk to, and we help them troubleshoot through it.

One of the things that happened in your administration here is the implementation of Ohio Resilience through Integrated Systems and Excellence, Ohio Rise, which seeks to coordinate care for about 50,000 kids with complex and expensive mental and behavioral health issues across several different agencies.

We're talking about like behavioral health, judicial system, all of that.

But still keeping families intact.

That program has done a lot to reduce emergency room visits.

Is that program staying on budget?

Are there problems in that program with.

I mean, with all the things that you're trying to do here.

Well, let me back up to the beginning of the whole journey, which was, you know, within a few days of taking this job, the governor said to me he wanted us to transform the Medicaid program.

And so I took this job with kind of two understandings.

Number one, the governor expects us to listen.

And the governor always operates with a sense of urgency.

So we undertook a process and listened very hard and very closely to people all over the state.

And everything that we did, including Ohio Rise, came out of the kind of feedback that we got from families and individuals that showed us that this was a group of young people who really needed to have, as the governor would say, somebody's waking up every day thinking about them.

And so and every other aspect of the program over the last, really, since we began the change in about 2020 came from the listening.

Now, you could also say, well, you bit off a lot.

Could you have done it a little more slowly?

Well, my answer to that is, you know, governor DeWine has a great sense of urgency.

And so, we we implemented Ohio Rise in response to what we were hearing.

We also knew, given the kind of change that it is, that it is not just about building some beds to take care of young people.

It's about developing community services in the schools.

Working with the basketball coach, you know, interacting with the police.

And so the, folks in new Jersey who, we patterned a lot of our work on, told us it would be a 15 year journey.

Now, I didn't share that with anybody for a long time, but I'm proud to say that, you know, today we have a toddler serving 50,000 children, and it still is a journey.

But the progress that we've made is absolutely remarkable.

We are looked at really across the country as the only state that has taken a comprehensive approach, not just one group of children or another group of children.

We're using data, a data assessment tool, in a way that no one in the country is using it.

And so we have all kinds of states that over the last year or two have been calling us to say, how did you do that?

Why did you do this and why did you do that?

So we were getting, you know, very strong information from other Medicaid programs about this being an important focus.

And we have made very good, incredible progress.

And we know that this is a journey about building communities.

It isn't just about building beds.

And in the most severe cases, you had families who were actually giving up custody of their kids to get them the treatments that they needed.

And that's one of the things you were trying to prevent here is, is that that situation?

That's exactly right.

Families who have a young person with this degree of of behavioral health challenge, if they have to be in the hospital for a long time or they have to be in an out of home treatment environment.

It is.

It is $1,000 a day and even moderate and reasonably well-to-do individuals can't afford that kind of an expense.

So part of this program, that and putting Ohio Rise together was to have some very specific components of it that enable us to identify kids before their family has to give up custody and begin then to bring them into the program and address their needs so that they are not forced, you know, into the custody of the state just because their family doesn't have that kind of money.

Are you concerned that your successors are really going to have to fight for that in the budget?

Because, as you just said, this is inherently expensive work that this program does.

Yeah, I you know, there's if there's one thing about Medicaid that's always true, it's change.

And I say that not only in a financial sense, but also in a policy sense.

There will be change.

There is change occurring in the health care economy.

And with all the new things that are coming out of Washington, so change is going to continue.

We we know that we have some difficult economic, we have some difficult economic situations now that we're having to address.

There will be for our General Assembly down the road, you know, further questions and issues that they're going to have to deal with.

And so I think the General Assembly will continue to scrutinize very closely everything that we're doing.

I think when they look at the math and they see that you can pay X amount to have a child out of state as compared to Y amount if they're at home and stay with their families, you know that the cost benefit will demonstrate itself.

One of the other things you did is you launched the Single Pharmacy Benefit Manager program in late 2022.

What's been the impact of that?

That's, as you may as you may remember, there was quite a controversy when the governor took office about spread pricing and the role of PBMs.

And there still is across the country.

When we implemented the, single PBM, it was very explicitly there at the direction statutory requirement of the General Assembly.

And it was to, first and foremost, to take all of the issues or problems that are evident or were evident, and to build a new approach to it that would try to alleviate those.

So, you know, we have unprecedented transparency in our rates in how the dispensing fee to pharmacies is set up.

We have now today, we have literally more than 99% of all the pharmacies that are located in the state of Ohio are participating in the Medicaid program.

We have, you know, there's just I could go on and on with more of the changes, but we are showing cost savings.

We've reduced administrative cost to the managed care plans by doing the administrative piece once and the response from pharmacists, across the state has been overwhelmingly appreciative and supportive.

You had to make some big moves when Covid hit, including the kind of expanding Medicaid coverage to people over that.

We've returned to pre-pandemic levels, which means people have to renew their eligibility.

The federal mega bill appears to require people to have to renew that every six months.

That sets up a situation where some people are just going to lose their Medicaid eligibility.

Yep.

Yeah.

And just a word about the pandemic.

What I discovered after the fact was we Ohio may have been the only state in the country that continued with all of our procurement and all of our design work that we've just been talking about.

So we were heads down.

No serious delays continued throughout the pandemic.

That was not the case across the country.

So at the same time we were dealing with the pandemic, and worked very hard, as you know, with the governor, the governor, the governor's office, the Department of Health.

So we learned an incredible amount through that process and unwinding that is serving us very well today.

And that's some of what, you know, the CMS, assistant director was commenting on that.

We learned a lot that that is helping us streamline how we do eligibility, use every tool at our disposal.

So and I could, you know, go on and on about that.

But yes, there is a desire to have a greater level of, oversight or greater, you know, more often have eligibility checks.

And so the federal law does now include six month eligibility.

Redetermination.

Now, we expect because of what we've learned, we expect that a great deal of that will be able to be done electronically through the exparte process, as it's called.

And so many, many, many people will not even get, you know, paperwork or things like that, but will be checking databases and doing all the required review.

So we've learned a lot.

We're putting it to use.

But you're right, every time we have to go through that process with an individual, especially if it if it requires getting paperwork or some of that kind of stuff, you worry that the person you know may have moved may not, you know, understand all the paperwork they're dealing with.

So that is something that we are paying attention to.

We've been planning for to make it as seamless as possible for Ohioans.

What's the status on instituting work requirements in Medicaid?

Because Ohio has gone through quite a saga of where, you know, we applied for that waiver and it was granted, and then Covid hit, and now we've applied for the waiver again.

What's the status of that?

And are you concerned about people losing eligibility there as well?

We as you say, we applied for a waiver, received it.

And then the Biden administration was not interested in having states implement it.

So, we submitted another waiver, which is currently pending before CMS.

And then the big beautiful bill when it passed created, or a requirement that does not necessarily require states to use one of these complicated waivers to do it.

Okay.

It's kind of an administrative straight up thing.

But so we're currently in discussions with CMS about, you know, do we use the waiver vehicle, do we use the other big beautiful bill vehicle?

But during 2026 will be implementing it, along with the changes in eligibility, and again, that's what we've been talking with other states about as well.

We're, we're positioned very well for we will be one of the earliest states to come online.

And so we're looking forward to it.

And that is it for this week.

For my colleagues.

The Statehouse News Bureau of Ohio Public Media.

Thanks for watching.

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Support for the Statehouse News Bureau comes from Medical Mutual, dedicated to the health and well-being of Ohioans, offering health insurance plans, as well as dental, vision and wellness programs to help people achieve their goals and remain healthy.

More at Med mutual.com.

The law offices of Porter, right, Morris and Arthur LLP.

Porter, right, is dedicated to bringing inspired legal outcomes to the Ohio business community.

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Right.

Com Porter Wright inspired every day.

You know, Ohio Education Association representing 120,000 educators who are united in their mission to create the excellent public schools.

Every child deserves more at o h e talk.