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Legislative oversight panel outlines Medicaid growth-rate process, requests actuarial funding
Summary
A Joint Medicaid Oversight Committee staffer told the Senate Medicaid Committee how JMOC sets a per-member growth rate, described data-sharing with the Department of Medicaid, and sought funding for actuarial contracts and staff for the 2026–27 biennium.
Jada Brady, staff to the Joint Medicaid Oversight Committee, told the Ohio Senate Medicaid Committee that JMOC has a statutory role in projecting Medicaid per-member cost growth and in setting a JMOC rate the executive must use for the state operating budget.
Brady said JMOC was created by statute to increase legislative oversight of Ohio’s Medicaid program and that the committee uses an outside actuarial firm and a per-member-per-month (PMPM) cost formula to measure utilization and unit-cost trends across fee-for-service and managed-care delivery systems. “The actuaries report projects the cost of continuing current Medicaid policy into the next biennium,” Brady said.
JMOC’s statutory projection requirement is established in Ohio Revised Code Section 103.414, Brady said, and the committee voted Oct. 17, 2024 to set the JMOC rate at 3.8% for state fiscal year 2026 and 3.7% for state fiscal year 2027. Brady told senators JMOC uses a confidentiality and data‑sharing agreement to allow its contracted actuary to receive weekly claims data from the Ohio Department of Medicaid (ODM) so projections reflect current claim activity.
Brady described budget components JMOC is asking the General Assembly to fund. She said JMOC budgets included funding for continued actuarial work and higher actuarial expenses in the second year of the biennium because of the timing of the rate-setting process. Brady said the committee budgets for actuarial services and staff support, and asked the Senate to fund the committee’s actuary and personnel to continue the PMPM analysis and oversight role.
Brady also described ongoing data and claims issues associated with ODM’s “next generation” system implementation, which she said required earlier and additional actuarial work to identify unpaid claims and eligibility problems. She said JMOC is budgeting to allow its actuary to analyze encounter and fee-for-service data weekly to monitor claims and growth-rate inputs.
Brady concluded by offering to answer committee questions. The committee had no changes to the minutes and approved them at the start of the hearing; no other formal committee actions were recorded during her appearance.
Looking ahead, JMOC and the department will continue exchanging weekly claims data to support the statutory PMPM projection required before the governor files a budget.
Context: JMOC’s rate-setting and data-sharing authority is intended to give the General Assembly an actuarial projection of continuing current Medicaid policy into the next biennium, so that budget proposals reflect projected utilization and unit-cost trends.
