Showdown looms over Medicaid in Ohio
Republican state lawmakers want to freeze Medicaid-expansion enrollment starting in July 2018, potentially cutting off health-care coverage for hundreds of thousands of low-income adults and likely setting up a veto showdown with Gov. John Kasich.
More than 700,000 Ohioans get health care through the Medicaid expansion, but no new enrollees would be permitted after July 1, 2018,
under a provision that’s expected to be part of the new two-year state budget that emerges from the Statehouse.
Those covered by the Medicaid expansion as of that date would continue to be covered, but only if they don’t get better employment and drop off the Medicaid rolls, something that happens regularly. The catch is that those who leave Medicaid could not return later even if they lose their job, unless they are getting mentalhealth or drug treatment.
However, no one could be added to the Medicaid expansion group starting in July of next year even if they need medical help for mental-health problems or drug use.
The Kasich administration would need to file a waiver to get federal approval for the freeze, which was one of more than 400 state budget provisions that a joint conference committee worked out late Tuesday, leading to expected full House and Senate budget votes on Wednesday afternoon.
Other expected resolutions include removing Senate language that softens restrictions on wind turbines, dropping language related to utility credit ratings and electricity bills and providing longer-term help for counties that are losing $209 million in annual Medicaid salestax revenue.
The expansion freeze would cause hundreds of thousands of poor Ohioans to lose health coverage and the state to forfeit hundreds of millions of dollars used to fight opioid abuse, according to the Kasich administration.
“When Arizona implemented a similar freeze in 2011, 70 percent of the people who were enrolled when the freeze took effect were not on the program 18 months later. If a similar result occurs in Ohio, more than 500,000 Ohioans could lose coverage,” according to a memo from Greg Moody, director of the Governor’s Office of Health Transformation.
That estimate may not take into account the exemption for current enrollees with drug or mental-health issues.
The freeze comes as health-care uncertainty swirls in Washington, where Republicans could end or significantly alter the Medicaid expansion. The federal government currently pays 95 percent of the cost of the expansion, and some Republicans are concerned about the growing size and cost of Medicaid.
Rep. Andrew Brenner, R-Powell, said if the federal government drops its share of the expansion to the more typical 60 percent covered for traditional Medicaid, it would cost the state $1.6 billion per year.
But the proposed state budget goes even further than Congress is considering, and Kasich, a big supporter of the Medicaid expansion, could veto the provision before he signs the budget bill on Friday, the final day of the fiscal year. He has pointed to the need to help those “in the shadows” and stresses how much the expansion does to help the mentally ill and drug addicted.
Of the nearly $1 billion Ohio spent on the drugaddiction crisis in 2016, Moody said, an estimated $650 million was paid for by Medicaid for drugaddiction and behavioral health services, including $279 million through the expansion.
Senate Republican leaders reportedly are saying they have the votes to override a veto, which takes a threefifths majority. The House may have the votes as well, but there is less certainty.
Lawmakers also are expected to ask Kasich to get federal permission to help counties and transit authorities that stand to lose more than $200 million a year because they and the state no longer could apply the sales tax to Medicaid managedcare services.
Those losses include $12 million annually for Franklin County and about $5 million for the Central Ohio Transit Authority.
Under the proposal, Kasich must seek federal approval to increase the franchise fee on health insurers to provide $207 million annually for six years for counties and transit systems, ending July 1, 2024. Kasich wants a fee increase large enough to cover the state’s loss but proposed only short-term relief for local governments.
Kasich’s budget director has said the governor opposes a permanent replacement of those local dollars, and some wonder if he’ll veto this latest proposal.
“It’s a little inconsistent for him to say that the counties shouldn’t rely on it since they’ve only had it for six years. It’s the same for the state,” said Sen. Matt Dolan, R-Chagrin Falls.
Plus, Dolan said, the counties are on the front lines of the opioid crisis, including foster care services and coroners.
“This is not a time to walk away from counties,” he said. “And public transportation is about creating jobs. If you look at where the jobs are, you need public transportation to get to them.”
Some of the other finalized budget issues would:
Establish a new ability for charter school sponsors to appeal their state ratings through an informal hearing.
No longer give automatic low scores to charter school sponsors who score zero points on portions of the evaluation, except for academic performance.
Set new graduation requirements for the Class of 2018 that allow attendance, gradepoint average and work options to be considered in obtaining a diploma, instead of having to meet new end-of-course scores.
Approve a provision that allows a K-12 e-school with at least 2,000 students and a sponsor “not rated ineffective or poor on its most recent evaluation” to divide itself into two or three schools.
Require the state to seek new Medicaid work requirements.
Permit the transfer of funds from the Bureau of Workers’ Compensation, Industrial Commission, Ohio EPA and others to balance the budget. Business and labor groups opposed this move.
Allow businesses to file municipal income taxes through the state, rather than through individual municipalities.