Feds must take close look at Ohio’s Medicaid scheme

When a proposed change in public policy prompts questions for which there are no straightforward answers, an independent review is appropriate.

Thus, the federal Centers for Medicare and Medicaid Services will determine whether a plan to require more than 1 million Ohioans to make monthly payments or lose their Medicaid coverage should be implemented.

Healthy Ohio, which is included in the state’s biennial budget, would result in 1.5 million Medicaid recipients contributing to a health savings account to help pay for their care. The changes to the existing program would take effect in 2018.

However, federal approval is needed, which is why the proposal will be submitted to Washington by June 30. But it won’t just be the changes to Ohio’s Medicaid program that will be submitted. Public comments during hearings on April 21 and May 2 and opinions from interested parties will also be part of the federal review process.

One of the key questions that deserves to be explored is this: What will happen to the recipients who fail to make the monthly payment and, therefore, lose their coverage?

According to Cleveland-based Center for Community Solutions, a think tank led by Ohio’s former Medicaid Director John Corlett, there could be broad “disenrollment” of foster children, women with cancer and other vulnerable beneficiaries.

“This overly complex and bureaucratic proposed waiver leaves too many questions unanswered and threatens to undo the progress Ohio has made to improve health outcomes, control costs and improve care,” Corlett said in a statement.

But one of the key state lawmakers behind Healthy Ohio contends that the plan’s critics are overlooking the plan’s efforts to get people to take healthier steps, such as preventive care.

“The intent of this program is to create incentives for people to get the very best care that they can, to engage and utilize the health-care system in a way that is going to benefit them,” said state Rep. Jim Butler, a Republican from Oakwood.

Point of contention

But it is the cost to be borne by recipients that has become a major point of contention.

When Ohio’s Republican Gov. John Kasich first proposed the Medicaid enrollee payment plan, he talked about individuals making more than 100 percent of the federal poverty level.

But the Republican-controlled General Assembly chose to expand the eligibility rules by requiring all non disabled adults on Medicaid, regardless of income, to pay up to $99 a year, or $8.25 a month, into a health savings account, The state would then contribute $1,000 annually into each person’s account to help pay for health services, The Plain Dealer of Cleveland has reported.

State projections indicate that enrollment in Medicaid will drop between 150,000 and 140,000 following the implementation of the changes, according to The Plain Dealer.

“If they drop out, it is just costing us more,” Steve Wagner, executive director of Ohio’s Universal Health Care Action Network, told the newspaper. “Then they end up not getting the preventive services and going to the hospital only when they are very sick, and that’s expensive.”

Therein lies the problem with what the Republicans in control of state government have proposed.

Indeed, it appears that the effect would be to undermine the expansion of Medicaid that Gov. Kasich implemented – over the objection of the GOP in the Legislature – in order to get increased funding from Washington under the Affordable Care Act. More than 673,000 Ohioans have enrolled in the program since the governor expanded it.

The possibility of thousands of Ohioans losing their health care coverage and once again having to choose between their medical needs and the necessities of life, such as food, should give officials at the Centers for Medicare and Medicaid Services pause.

U.S. Sen. Sherrod Brown, D-Ohio, long an advocate of health-care coverage for all Americans, framed the argument in support of Medicaid recipients thusly: “These are hardworking Ohioans who aren’t looking for a handout.”