Ohio Department of Medicaid · November 20, 2025 · Primary source
"Next Generation” Medicaid Overhaul Earns Ohio National Spotlight "Next Generation” Medicaid Overhaul Earns Ohio National Spotlight. 2025 NAMD Spotlight Award Honors Next Generation Program Serving 3 Million Ohioans. November 20, 2025
Summary
The National Association of Medicaid Directors awarded Ohio's Department of Medicaid the 2025 Spotlight Award for its multi-year Next Generation transformation, which overhauled managed care contracting, pharmacy benefit management, and behavioral health services for more than three million Medicaid enrollees. Key structural elements include the Single Pharmacy Benefit Manager that eliminated spread pricing and saved $140 million in two years, the OhioRISE pediatric behavioral health managed care program now serving nearly 50,000 youth, and the Ohio Medicaid Enterprise System digital gateway for provider credentialing and transactions. The award highlights Ohio's model as a potential template for other state Medicaid programs.
What this may mean
The recognition consolidates Ohio's position as a reference model for state Medicaid managed care reform, particularly its SPBM spread-pricing elimination and OhioRISE behavioral health carve-in, which other state Medicaid agencies and federal policymakers are evaluating for replication. The NAMD award itself creates no new legal obligation but signals that these structural features, including elimination of spread pricing and integrated behavioral health managed care, are gaining national endorsement. Providers and managed care organizations operating in multiple states may face analogous program structures as other states adopt similar reforms.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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