Ohio seeks Medicaid work requirements

Resident exemption from Obamacare mandate sought too.

Ohio will WASHINGTON — soon ask the federal government to waive an Obamacare requirement that nearly everyone in the state get health insurance coverage.

It will also ask permission to make some Medicaid recipients work 20 hours a week, go to school or take on similar activities. The state announced both these actions today, anticipating it will submit separate applications to Washington in about a month, after holding public hearings.

Critics have cautioned the work requirement is either unneeded or could be onerous. But the Ohio Department of Medicaid estimates that only about 5 percent of the state’s current 700,00 residents enrolled in Medicaid as a result of the Affordable Care Act — about 36,000 people — would actually be affected.

That’s because an overwhelming majority of the entire pool work already or would be exempt because of age, illness or caregiver responsibilities. As for the others — those who would be required to work or else lose their Medicaid coverage — the state laid out its rationale in a new notice.

“It is widely recognized that poverty, food insecurity, housing, and employment status can impact an individual’s overall health,” the Department of Medicaid notice said. “Indeed, there is a strong connection between improved health and being employed.”

Several Ohio Democrats, however, said the state’s actions could backfire if the economy weakens or people have trouble finding work.

“The minimal cost saving are not worth the lives that will be harmed and lost due to these changes,” said a statement from state Rep. Emilia Strong Sykes of Akron, who with fellow Democratic Rep. Nickie J. Antonio called the state’s actions misguided and morally wrong.

Both requests are likely to face favorable review from President Donald Trump’s administration, which just in the last month has granted requests from Kentucky and Indiana to add work requirements to their Medicaid programs — the first work waivers in the nation. And both of Ohio’s requests have already been approved, at least in concept, by the Republican-dominated Ohio legislature. The legislature used a budget bill last summer, in fact, to require that the state seek these waivers.

The Medicaid work requirement, covering only Ohioans who became eligible for the public health program as a result of the Affordable Care Act, or Obamacare, would start July 1 if approved in time, said Barbara Sears, director of the Ohio Department of Medicaid. Medicaid used to be limited to those with family incomes below the federal poverty level, but the ACA expanded it to those with incomes up to 138 percent of that level, or $34,638 for a family of four.

The exemption from having to buy private insurance would affect Ohioans making more, although a majority buying such insurance through the ACA get some or all of their premiums covered with federal tax subsidies. The waiver would allow all Ohioans to decide for themselves starting next January whether to get health coverage or leave medical needs to chance or their personal ability to pay doctor and hospital bills.

The Affordable Care Act, also known as Obamacare, requires nearly everyone to have coverage through private insurers or, if incomes are low, through Medicaid. But it also allows states to experiment with other health care approaches by applying for certain waivers from ACA rules. The waivers have become easier to get under Trump.

The Ohio Department of Insurance, or ODI, and the Ohio Department of Medicaid both said they will ask the U.S. Department of Health and Human Services for such waivers.