GOP fight means 3 million Ohioans could lose Medicaid

Republican COLUMBUS — state lawmakers’ unhappiness with Ohio’s Medicaid expansion is setting up a high-stakes showdown that could just could end all — — Medicaid funding by May 2018.

That worst-case scenario would translate into a $1 billion-a-year cut in health-care services used by more than 3 million lower-income Ohioans ranging from nursing home residents to pregnant women to those fighting drug addiction.

The administration of Gov. John Kasich is spelling out the potential health-care catastrophe now, ahead of a key vote Oct. 30, in an attempt to muster support from the plethora of businesses and individuals who would be affected, said Greg Moody, director of the Governor’s Office of Health Transformation.

Part of the reason the additional support is needed, Moody acknowledged, is that numerous lawmakers are frustrated with what they see as a lack of accurate fiscal information — especially after several years of Medicaid spending that came in below state estimates. Moody said he had thought legislators would view the past underspending as a good thing. Regardless, he said the current budget makes it clear that all the requested funds are needed to fully compensate Medicaid providers for their services.

All this likely will be on the table Oct. 30 when the administration appears before the state Controlling Board, a panel of four Republican and two Democratic legislators headed by a Kasich appointee.

Because of lawmakers’ concerns about Medicaid spending, they added an unusual provision to the two-year state budget that took effect July 1. Instead of allowing the Kasich administration to simply spend the state’s allocation for Medicaid as in years past, legislators mandated that the administration get permission from the Controlling Board before using any of the budgeted money.

Moody said he initially thought the request would be routine. But as the administration prepared to bring the issue to the Controlling Board in September, Moody said it learned the entreaty might be rejected. Thus it was delayed until this month.

“We’re hoping the speaker (of the House) and Senate president will provide the votes,” Moody said.

Rep. Al Landis, R-Dover, was just recently appointed to the Controlling Board, and said he’s going into the Medicaid discussion with an open mind.

“I’m going to study, listen and ask the right questions and move forward with the best information we have and make the best decision we can,” he said.

Rep. Ryan Smith, R-Bidwell, the chairman of the House Finance Committee who until recently sat on Controlling Board, said he thought the more difficult Medicaid funding discussions would not come until at least next year, instead of with the first request.

“But it forces the discussion and we dig in a little deeper,” he said.

Controlling Board members Rep. Scott Ryan, R-Newark, and Sen. Bill Coley, R-West Chester, were among the Republicans who grilled the Kasich administration last month during a hearing before a separate Medicaid-focused panel.

Ryan and others questioned the administration’s Medicaid cost estimates, arguing they have repeatedly been too high, causing significant underspending by the end of the year. The also pushed back against administration assertions that the Medicaid program already faces a $1.3 billion shortfall.

Ryan said the proposal will get due diligence, but others acknowledged the lingering concerns about the accuracy of the administration’s Medicaid figures.

“The inconsistency of the numbers is very frustrating,” Smith said. “When you say you have a balanced budget but then all of a sudden blame the legislature for cuts to hospitals, I’m scratching my head with that. It’s a tough-enough business when we’re not moving the goal posts.”

Rather than keeping current spending levels until the Medicaid well runs dry in May, the Kasich administration could levy a cut of 16 percent starting Jan. 1 to all Medicaid recipients except nursing homes, whose funding is mandated by state law. But Moody said the administration believes everyone should share in any cuts, and holding off until May when the money runs out means nursing homes would be included in the pain, too.

Ironically, it was the state Controlling Board that made Kasich’s Medicaid expansion possible in the first place.

The GOP-controlled legislature wouldn’t approve it in 2013, so the governor went to the spending panel.