· Carly Sfregola
Ohio Wins National Recognition for Comprehensive Overhaul of Medicaid
The Ohio Department of Medicaid has been awarded the 2025 National Association of Medicaid Directors (NAMD) Spotlight Award for its comprehensive transformation of the state’s Medicaid program. The “Next Generation” initiative represents one of the most ambitious statewide Medicaid re-designs in the nation, which was successfully staged and completed even while continuing to serve three million Ohioans.
“The governor’s challenge in 2019 gave us a clear North Star: putting the individual first. That principle organized all our transformation work and guided everything we did,” said Maureen Corcoran, the former Director of the Ohio Department of Medicaid who spearheaded the transformation. “Change in health care is usually slow and incremental. We wanted to make a dramatic step up and leapfrog to the next generation based on what Ohio and other states had learned.”
A Transformation During the Pandemic
Beginning in late 2019, Ohio launched more than a dozen major procurements and went live with new programs starting in spring 2022—all while navigating the COVID-19 pandemic. Rather than tackle changes piecemeal, Ohio chose to transform multiple interconnected systems simultaneously. The transformation continued uninterrupted throughout the public health emergency, with the team maintaining urgency despite unprecedented challenges.
“Ohio showed us what is possible when the interests and experience of members are driving influences in comprehensive program re-design. This human-centered approach has yielded exciting results,” said Kate McEvoy, Executive Director of the National Association of Medicaid Directors.
OhioRISE: Breakthrough Results for Vulnerable Youth
A centerpiece of the transformation is OhioRISE, a first-of-its-kind specialized managed care program for children and youth with complex behavioral health and multi-system needs.
“We heard clearly from families: children served by multiple systems with complex behavioral health needs require a specialty focus,” Corcoran explained. “That gave birth to OhioRISE.”
The program now serves more than 49,500 children, including 4,300 kids in foster care. In its first three years, OhioRISE has expanded Intensive Home-Based Treatment to 76 of Ohio’s 88 counties—up from less than half, reaching roughly 90% of the state—while developing nearly 4,000 program eligibility assessors and adding 800 new care coordinators across all 88 counties. The program has also reduced the number of youth sent out of state for intensive care by 30%. OhioRISE outperformed traditional Medicaid managed care plans by more than 66% in key behavioral health quality measures in less than three years.
Innovation Across the System
The Next Generation transformation extends beyond OhioRISE to include:
Single Pharmacy Benefit Manager (SPBM): Eliminated “spread pricing” and brought unprecedented transparency to drug costs, saving $140 million in net pharmacy savings in the first two years while paying pharmacies an average of $9 per prescription compared to 73 cents under previous models. Over 99% of Ohio pharmacies now participate in the network.
Outcomes Acceleration for Kids (OAK): A first-in-the-nation partnership between state government, all Medicaid managed care plans, and all seven children’s hospitals to collaboratively improve outcomes for asthma, behavioral health, sickle cell disease, and well-child visits.
Ohio Medicaid Enterprise System (OMES): The first state in the nation to implement a “one-front-door” gateway for Medicaid transactions, with centralized credentialing that allows providers to contract with multiple managed care organizations more easily.
A New Model of Collaboration: Central to the transformation is the new partnership model among Ohio’s nine managed care organizations. Plan CEOs and presidents meet at least weekly to work collectively on state-defined initiatives rather than competing.
“This recognition honors the incredible work of our team and partners who made this transformation possible,” said Scott Partika, current Director of the Ohio Department of Medicaid. “We’re committed to keeping this momentum going and taking the work forward to ensure we continue putting individuals first in everything we do.”
About NAMD’s Spotlight Award
The National Association of Medicaid Directors’ annual Spotlight Award recognizes exceptional leadership and innovation in Medicaid administration. The 2025 award specifically highlighted achievements that demonstrate excellence in driving value through improved member experience and efficient use of taxpayer resources. Learn more about the other 2025 winners here.