July 25, 2023

Mr. Don Kline

Chief Operating Officer
Bon Secours Mercy Health

Delivery Via Electronic Mail

Dear Mr. Kline:

Thank you for your letter of July 20, 2023, following up on the discussion the Ohio Department
of Medicaid (ODM) coordinated between Bon Secours Mercy Health (BSMH) and Anthem Blue
Cross Blue Shield (Anthem) relative to the negotiations between BSMH and Anthem. We value
your partnership with ODM and many of our Next Generation managed care organizations, and
for that reason ODM thought it would be fitting to serve as an “honest broker” in attempting to
attain a meaningful transition as the Anthem Ohio Medicaid relationship between BSMH and
Anthem comes to a close.

As an initial matter, ODM’s primary consideration is the care and well-being of the over 3.5
million Ohioans served by the Ohio Medicaid program. Thus, I and other members of my
leadership team were pleased to hear you confirm more than once during our conversation
that the current dispute between BSMH and Anthem is wholly unrelated to the Ohio Medicaid
program or Anthem Ohio Medicaid. As we discussed during the call, BSMH and Anthem agreed
to work together to develop communications to members that ODM, Anthem Ohio Medicaid,
and BSMH could use in interaction with members, and disseminate those communications and
principles to staff at both BSMH and Anthem Ohio Medicaid. Unfortunately, this did not occur.

During our July 1 discussion, BSMH and Anthem also discussed a 60- to 90-day transition or
blanket single case agreement (SCA), with individual considerations taken into account to
prevent disruption to Anthem Ohio Medicaid members. Individuals in a longer course of care
for a significant illness who did not want to change either their relationship with BSMH or their
Ohio Medicaid coverage through Anthem would be allowed to continue their current course of
treatment without any further authorization, other than ordinarily required on a particular
claim or procedure. For those members, BSMH said it would continue to accept the Ohio
Medicaid rate.
Mr. Don Kline
Page 2
July 25, 2023

It thus came as a surprise to us that in subsequent communications to ODM, BSMH announced

that it would only accept Ohio Medicaid members through July 31, 2023. That date was not
discussed during our conference on July 1, and is entirely at odds with the arrangement ODM
understood the parties to have reached. Regardless of that apparent disconnect, ODM
suggested to Anthem that it proceed under the assumption that the agreement between BSMH
and Anthem Ohio Medicaid will cease on July 31, and Anthem Ohio Medicaid has taken steps to
that end.

In your letter of July 20, you identified several “insights” about Anthem that on their face
appear not to be specific to Anthem Ohio Medicaid. The ODM team will review those insights
to determine what relationship, if any, they have to the Ohio Medicaid program.

Your letter of July 20 also requested that ODM take several “actions” relative to Anthem Ohio
Medicaid. These requests appear to contradict the core tenet of prioritizing the needs of each
individual Ohioan served by Medicaid. However, to the extent that we are all in agreement
that the Medicaid members with whom Anthem Ohio Medicaid and BSMH share a relationship
do not get caught in the middle of this non-Medicaid dispute, ODM believes it necessary to
elaborate further on the steps it has been and will continue to take regarding those members.

First, you proposed ODM use a script when messaging Anthem Ohio Medicaid members that
Mercy Health is no longer contracted with Anthem and recommending that those members
change to another Ohio Medicaid managed care organization (MCO). As indicated when we
met, we must provide, and honor to the greatest extent possible, individuals’ choice of health
plan. It is our responsibility to provide the individual with all the information to make the best
and most informed choice to meet their needs. ODM’s enrollment broker will continue to assist
members who are selecting an MCO to identify one or more of the MCOs that best support
their continuity of care, taking into consideration the ongoing provider relationships the
member wishes to maintain. If a member wishes to maintain a continuing relationship with
BSMH, the enrollment broker will identify for that member that Mercy Health is out-of-network
for Anthem Ohio Medicaid and assist them with selecting an alternative MCO.

Second, you have proposed that ODM ensure Anthem Ohio Medicaid members and other
newly eligible Medicaid members are made aware that Mercy Health is no longer in-network
with Anthem Ohio Medicaid. Such a communication will not be necessary. Existing Ohio
Mr. Don Kline
Page 3
July 25, 2023

Medicaid members seeking to continue a relationship with Mercy Health may make a Just
Cause request at any time to enroll in another MCO. Newly eligible members are assigned to
an MCO by our enrollment broker taking into account several factors, including continuity of
assignment with other family members and continuity of the member’s care. If those factors
favor a particular MCO, that MCO will be assigned for the member. However, the member will
then have 90 days to select another MCO, as member choice is the primary consideration in any
ongoing assignment.

Third, you recommend that ODM “freeze new enrollment in Anthem [Ohio Medicaid] for a
period of ninety (90) days to ensure that new patients do not enroll without the understanding
that they would not have long-term access to Mercy Health.” Inasmuch as BSMH and ODM
agree that the current dispute between BSMH and Anthem is entirely unrelated to the Ohio
Medicaid program, this recommendation is unnecessary. Members will continue to be assigned
to and/or select their MCO based on continuing ODM principles and practices.

Fourth, you reiterate your request that ODM “conduct a block transfer” of all Anthem Ohio
Medicaid members “who have seen a Mercy Health provider in the last twelve (12) months” to
other Ohio Medicaid MCOs. I specifically rejected that request when you made it verbally
during our call on July 1, 2023, and explained why. Moreover, like BSMH’s proposed
enrollment freeze, a block transfer would be disruptive to individuals, as well as unacceptably
and impermissibly overbroad. Regardless of how often a member may have seen a Mercy
Health provider in the past, 1 he or she may choose to stay with Anthem Ohio Medicaid for
myriad other reasons, and ODM will not override that choice, especially based on a dispute
unrelated to the Medicaid program.

Finally, your letter recommends that ODM implement a special open enrollment for 90 days to
allow for Just Cause transfers for any other Anthem Ohio Medicaid member to select an
alternative MCO. In fact, for the past several weeks, ODM’s enrollment broker has been
processing transfers without restriction for any Anthem Ohio Medicaid member who has made
a request to switch to another MCO. This approach will not be open-ended, and ODM will

1
For example, an Anthem Ohio Medicaid member from Columbus, Ohio, who happened to
need emergency treatment from a Mercy Health provider while on a trip through Toledo, would
be included in your request.
Mr. Don Kline
Page 4
July 25, 2023

determine when the best interests of our members and the Ohio Medicaid program dictate
returning to our established Just Cause process.

As a final note, Ohio Medicaid is presently in the process of notifying all Ohio Medicaid
members that the annual open enrollment is forthcoming in the month of November, during
which any member can freely choose to enroll in any Ohio Medicaid plan.

It is indeed unfortunate that Ohio Medicaid members find themselves in the position of having
to make potentially urgent or otherwise significant health care decisions because of a
disagreement between two established and committed health care organizations that have told
us that they have these members’ best interests at heart. ODM will not use its members as an
incentive to force a resolution to that commercial, non-Medicaid disagreement. I strongly
encourage BSMH and Anthem to put their business dispute on another track and leave
individuals served by Ohio Medicaid out of it going forward.

Sincerely,

Maureen M. Corcoran, Director

CC: Steven T. Voigt, ODM, Deputy Director, Chief Legal Counsel, Chief Ethics Officer
James G. Tassie, ODM, Deputy Director, Office of Managed Care