Highlight on Ohio: Governor, lawmakers may tweak expanded Medicaid system

Ohio’s Republican governor, a rumored presidential candidate, broke ranks from his fellow party members and accepted federal funding to expand Medicaid in his state, but recent proposals indicate that he and his fellow state lawmakers are determined to make changes to the program. In 2013,  Governor John Kasich accepted federal funding under the Patient Protection and Affordable Care Act (ACA), which provided 100 percent federal funding for the expansion over its first few years.

As the Fiscal Times reports, Kasich has stated that not accepting the federal funding for the Medicaid expansion would have been  “economically wrong and morally wrong.” In response to the criticism he faced from other Republican lawmakers, Kasich adds, “I said I want to take $14 billion of Ohio money back to Ohio, away from Washington in this whole Medicaid thing,” and he further stated, “Why do I want the poor people, the working poor, to spend all their time in emergency rooms, driving up the costs for all of us to pay?” According to John McCarthy, Ohio Medicaid Director, who testified before the Ohio House Finance Subcommittee on Health and Human Services on February 26, 2015, over 490,000 Ohio residents were added to Medicaid coverage in 2014.

In addition to expanding Medicaid in his state, Kasich’s administration has recently introduced what it terms “A New Blueprint for Ohio,” which details his budget proposal for the 2016-2017 fiscal year. Kasich’s budget proposals includes premiums for certain Medicaid recipients who are at or above the federal poverty level, which for 2015 was $11,770 for an individual. Kasich has stated that these premiums are similar to what an individual would pay for coverage through one of the exchanges under the ACA. The Sandusky Register reports that few current Medicaid recipients would actually be required to pay the premiums under the new program. It is estimated that out of 2.9 million covered by Medicaid in Ohio, only 100,000 live at or above the federal poverty line and would thus be required to pay the premium. However, Ohio will be required to seek federal authority before it can implement Kasich’s premium proposal.

Governor Kasich is not alone in his proposed changes to the Ohio Medicaid program; other Ohio Republicans have some ideas of their own. The Bucyrus (OH) Telegraph-Forum is reporting that Ohio lawmakers have proposed requiring certain Medicaid recipients to invest 2 percent of their household income or $1, whichever is greater, into a state-managed health savings accounts called “Buckeye accounts.” The State of Ohio would contribute $1000 per adult and $500 per child per year. The contributions would carry over to the next year provided that the recipients meet certain requirements, such as getting an annual physical. The money would be used for doctor’s visits and other treatments. Lawmakers are expected to vote on the plan this week, which is modeled after a similar one in Indiana that recently received approval by the federal government.

Now that the Medicaid expansion has been in effect for a few years in Ohio, federal funding will begin to decline in 2017. Cincinatti.com is reporting that one conservative lawmaker, Jim Butler, R-Oakwood, who previously considered introducing a budget proposal that would prohibit Ohio from paying its share of the Medicaid expansion, has now dropped the idea.

The budget will be hammered out over the next couple of weeks and will certainly contain changes to the Medicaid system in Ohio, but whose changes are implemented remains in question.