MetroHealth System received approval from federal regulators on a complex legal maneuver that could extend Medicaid coverage to as many as 30,000 people in Cuyahoga County earlier than they would qualify for the coverage if the state expands eligibility in 2014 under the Patient Protection and Affordable Care Act. The health system, which is subsidized by Cuyahoga County, has been working on the waiver since the fall of 2011. The plan would extend healthcare coverage for county residents ages 19 to 64 who are uninsured, not eligible for regular Medicaid and have an income at or below 133% of the federal poverty level, which equates to $14,856 for an individual. MetroHealth plans to start enrolling patients immediately. “It doesn’t meet the needs of everyone, but it meets the needs of a significant number of our patients,” said John Corlett, MetroHealth’s vice president of government relations and community affairs. Because MetroHealth is a public entity, it plans to use its $36 million county subsidy to draw about $64 million in additional federal matching funds to finance the Medicaid expansion, which the health system has dubbed “MetroHealth Care Plus.” The federal approval of the waiver comes after Gov. John Kasich’s announcement that he wants Ohio to move forward with an expansion of Medicaid under the healthcare reform law. Expecting an influx of newly insured patients, MetroHealth last year finished tweaking its primarycare operations at its satellite clinics and is doing the same for its specialty service lines. Last October, Cook County in Illinois started enrolling individuals in a similar program on a much larger scale. The Cook County program immediately extended coverage to 115,000 individuals who wouldn’t be eligible for Medicaid until 2014.