Governor Establishes Executive Medicaid Management Administration

As called for in the biennial budget, Governor Ted Strickland today signed an executive order establishing the Executive Medicaid Management Administration (EMMA), an independent state office that will coordinate the management and implementation of the Ohio Medicaid program across state agencies.

"In order to provide the best value to Ohio taxpayers, we must improve the way the Medicaid program is administered," Strickland said. "The Executive Medicaid Management Administration will ensure that Medicaid services are coordinated and delivered efficiently and cost effectively."

Because of its size, several agencies currently share responsibility for Ohio's Medicaid program, which has resulted in fragmentation of the program's policies and processes.

EMMA will work to facilitate efficiency in Medicaid programs and operations and eliminate duplicate functions. In addition, EMMA will facilitate Ohio's compliance with federal Medicaid regulations, avoid conflicting policy decisions and maximize federal funding by making timely and effective decisions.

Strickland has appointed Cristal Thomas as the executive director for EMMA. Thomas currently serves as the assistant director of Ohio Health Plans at the Ohio Department of Job and Family Services. As executive director of EMMA, she will be a member of the governor's Cabinet.

Thomas will be responsible for developing a governance structure for EMMA, preparing an operating budget for the office and providing strategic direction and management for major Medicaid policies and functions.

The executive director and her staff will work directly with a council of Cabinet-agency partners to implement EMMA's responsibilities.

The Ohio Department of Job and Family Services will continue to serve as the state's single Medicaid agency. Federal law requires one state agency to assume responsibility for Medicaid grants and waivers, administer the state Medicaid plan, and ensure that all activities are conducted in line with federal laws and regulations.

EMMA will be required to submit an annual report to the governor and legislative leaders updating them on its progress.

The entire executive order is below:

Executive Order 2007 - 36S

Creating the Executive Medicaid Management Administration

1. The Provision of Health Services through the Ohio Medicaid Program. The Ohio Medicaid Program is a medical financing and service delivery system. It impacts all facets of Ohio's healthcare system by providing health care coverage as a safety net to uninsured Ohioans and incorporating cost sharing, disease prevention and personal wellness principles. Consequently, the provision of health services through the Program allows the State to facilitate improving the health and well-being of enrollees, while remaining accountable to all Ohioans and affordable for the State.
2. The Decentralization of Ohio's Medicaid Program Reduces the Provision of Efficient Services. Medicaid is one of the largest programs in Ohio in terms of its budget and the number of Ohioans it serves. Because of the scope and magnitude of Ohio's Medicaid Program, responsibility for its administration has been shared by multiple state departments, resulting in fragmentation of Medicaid policies, processes, and accountability.
3. Creation of the Executive Medicaid Management Administration. In order for the State to maximize efficient and effective delivery of health care to its citizens that rely upon Medicaid services, I hereby order the creation of the Executive Medicaid Management Administration ("EMMA"), which shall serve as the central coordinating body to manage the Ohio Medicaid Program across all state agencies. The role of the EMMA will be to coordinate the management of Ohio's Medicaid Program by:
1. coordinating Ohio's Medicaid policies to facilitate program and operational efficiency, including the elimination of duplication of functions;
2. implementing appropriate recommendations of the Ohio Medicaid Administrative Study Council;
3. facilitating Ohio's compliance with federal Medicaid laws, regulations, and policies, avoiding conflicting policy decisions, and enabling timely and effective decision making in order to maximize federal funding.
4. Appointment and Duties of the Executive Director for the EMMA. I will appoint an Executive Director to lead the EMMA. The Executive Director will be responsible for the effective operation of the EMMA by:
1. developing a governance structure for decision-making;
2. preparing an operating budget;
3. providing strategic direction and management around key Medicaid policies and functions including, but not limited to, information technology, program integrity, resource optimization, and interaction with local governments.
   In order to carry out these responsibilities, the Executive Director of the EMMA shall employ and fix the compensation of the EMMA personnel, who shall be in the unclassified civil service. The Executive Director will be the appointing authority for the EMMA and will be responsible for making all employment decisions relating to the EMMA including, but not limited to, hiring, firing, disciplining, and promoting employees.
5. Composition of the EMMA. In addition to the Executive Director, the EMMA will be comprised of:
1. a council of cabinet-agency partners consisting of Directors from the Departments of Alcohol and Drug Addiction Services, Aging, Budget and Management, Health, Job and Family Services, Mental Retardation and Developmental Disabilities, Mental Health; and the Superintendent of Public Instruction, who will provide advice and guidance for the implementation of the EMMA's responsibilities;
2. the EMMA staff;
3. subcommittees with representation from the Medicaid staff of the cabinet agencies that have Medicaid-related responsibilities.
6. The Ohio Department of Job and Family Services Will Remain the Single State Medicaid Agency. Federal law requires every state to appoint one agency to be responsible for applying for Medicaid grants or waivers, administering and amending the state Medicaid plan, and ensuring that activities such as claims processing, drawing down Federal matching funds, and program integrity are conducted in compliance with federal law and regulations. Traditionally, the Ohio Department of Job and Family Services ("ODJFS") has fulfilled this responsibility and, because it has established the infrastructure to competently fill this need, ODJFS will continue to serve as the single state Medicaid agency.
7. The Ability of the EMMA to Enter into Contracts. As the Executive Director deems necessary, the EMMA shall contract with state and/or private agencies for services in order to facilitate the implementation and operation of the EMMA's responsibilities, based on demonstrated experience and expertise in administration, management, data handling, actuarial studies, quality assurance, or other necessary skills.
8. Annual Report Regarding the EMMA's Progress. Beginning November 15, 2008, and every November 15 thereafter, the Executive Director of the EMMA shall submit a written report to me, the Speaker of the House of Representatives, the Minority Leader of the House of Representatives, the President of the Senate, the Minority Leader of the Senate, and the members of the Joint Legislative Committee on Medicaid Technology and Reform, describing the activities of the EMMA and providing an update on its progress.
9. I signed this Executive Order on December 10, 2007 in Columbus, Ohio and it will not expire unless it is rescinded.

Ted Strickland, Governor