Medicaid: scrutiny, but no freeze
A push by conservatives in the Ohio House to gut Medicaid expansion was rejected Monday by Republican leaders, but they did agree to keep closer tabs on spending before recommending passage of the two-year state budget.
The plan to freeze expansion enrollment, which would have dramatically lowered Medicaid rolls over time, was not part of the dozens of budget changes made Monday. House Finance Committee Chairman Ryan Smith, R-Bidwell, said a freeze likely would get bogged down in court “because we’d be treating the same class of people differently.”
But some House Republicans remain adamant about not voting for anything that even smells like support for Medicaid expansion, which covers 715,000 Ohioans.
Republicans voted to require approval from the Controlling Board, a bipartisan group of lawmakers headed by a gubernatorial appointee, before money is spent to insure the low-income adults on the expansion rolls.
“It gives us a little bit of balance of power between the branches and inserts us into the process a little further,” Smith said.
Republicans even voted to erase the word “expansion” out of the law.
“Expansion seems to be a volatile word around here,” Smith said.
Gov. John Kasich’s 2014 expansion of eligibility for the tax-funded health-insurance program has provided health coverage to poor adults, including 43 percent working low-income jobs and more than 500,000 who have received treatment for mental-health and/or addiction issues.
Republicans rejected a host of amendments sought by Democrats, including one to exempt veterans, pregnant women and new mothers, recovering addicts and the terminally ill from Medicaid work requirements previously added to the bill by Republicans.
Republicans also approved giving nursing homes another $100 million over two years. If nursing homes stay under a $2.7 billion spending cap, they get their full rates. The budget puts hospitals under a similar system.
Peter Van Runkle, executive director of the Ohio Health Care Association Administration, supports the change. Typically, he said, the administration overestimates how much nursing homes will spend. “We’re also banking on that,” he said.
“We’re essentially looking at trading cuts that we know were going to happen under the governor’s proposal for cuts that may or may not happen depending on our performance and spending,” he said.
The budget restores nursing home rates that Kasich proposed to cut.
“There was a lot of commitment to restore some rates,” Smith said. “They have staffing ratios, so they’re somewhat in a box.”
Most Democrats voted against the budget.
Rep. Alicia Reece, D-Cincinnati, said she appreciated the $171 million the House added to combat the opioid crisis but doesn’t think it’s enough — and it might not materialize at all considering the continued drop in state tax revenue.
“I wish we could wait until after Thursday, because there will be new numbers out,” she said, referring to April estimates from the Office of Budget and Management. “On Thursday, the bottom might drop out.”
The House made changes that, Smith said, got $630 million of the way toward the $800 million in cuts needed to bring the budget in balance, according to state budget office estimates. There is speculation among some who know the budget that April revenue — April is a key month for tax collection — is going to come in well under estimates.
But, said Smith, “I feel very good about this budget in terms of where we’re at and where we’re headed.”
A full House vote on the budget is expected today. House Republicans, who control the chamber 66-33, approved a host of additional budget amendments Monday, such as:
Reducing the phase-out of tangible personal propertytax reimbursements starting in 2020. This would mean a smaller reduction for more than 100 districts, including Columbus and Worthington.
Adding $5.1 million to help school districts whose funding is capped but that also are losing tangible personal property-tax reimbursements. For about 20 districts, they will be paid either the amount of the tax loss or the state funding they did not get because of the cap, whichever is less.
Cutting $1 million from Educational Service Centers, a few days after the House increased funding by $8 million.
Establishing $1 million to begin purchasing new voting machines.
Earmarking $750,000 per year for the Star House
“We’re essentially looking at trading cuts that we know were going to happen under the governor’s proposal for cuts that may or may not happen depending on our performance and spending.”
— Peter Van Runkle, executive director of the Ohio Health Care Association Administration
Drop-In Center at Ohio State University.
Allowing notaries to set their own fees.
Permitting a county to raise its piggyback salestax rate in increments of 0.05 percent instead of 0.25 percent.
Requiring private schools to publish on their websites their enrollment, policy on employee background checks, and curricula and reading lists for each grade.
Creating a pilot program in Franklin County to develop software that helps Medicaid recipients remember appointments and locate transportation.
Expanding the types of liquor permit holders that can offer samples of beer, wine or liquor in casinos.
Diverting unused money in the Lakes in Distress Fund to engineering and construction of storm-water facilities in Millersport and Buckeye Lake.
Directing the Joint Medicaid Oversight Committee to study high-risk pools for uninsured residents and the feasibility of implementing a high-risk pool in Ohio.