Cuts to Medicaid for Ohioans with disabilities could take away home care and job help

(Ohio Capital Journal) — As the Ohio Senate moves forward with its budget proposal, advocates for Medicaid are hoping changes can be made to avoid significant impacts to low income residents, elderly Ohioans, and people with disabilities.

Funding from Medicaid allows 3 million Ohioans access to health care services, including more than 770,000 who receive them through the Medicaid expansion program instituted in 2014.

That expansion program allows people who weren't eligible for the traditional Medicaid programs but were still in categories of need to access health care. The existence of that program dropped the uninsured rate in Ohio to historic levels, according to the Health Policy Institute of Ohio.

Along with health care, Medicaid dollars help with services that aren't necessarily connected to medical treatment, like home care, employment help, transportation, and a direct care provider who helps with all of those things.

"In many cases, if there wasn't Medicaid dollars behind it, I know of many people whose ability to live outside of a hospital or in the community would be threatened," said Jules Patalita, a disability rights advocate for Sylvania-based The Ability Center.

So advocates were disappointed to see the Ohio Senate maintain a provision from both the Ohio House's and Gov. Mike DeWine's budget proposals that would eliminate the Medicaid expansion group if the federal government reduces their level of support (currently at 90%) by even 1%.

"This would be a substantial loss for many working Ohioans," said Kathryn Poe, researcher for the think tank Policy Matters Ohio.

Also included in the Senate's budget proposal is the elimination of a Medicaid waiver that "would have provided continuous coverage for kids up to age 3," Poe said, and a separate section of the budget that would "allow the state to pause, eliminate or change other funds related to all other federal grants, should Congress adjust or eliminate funding for that program."

Poe did praise the Senate proposal for removing a House-submitted provision limiting Medicaid reimbursement for doulas to only six Ohio counties.

"This will ensure that Ohio parents continue to have access to culturally appropriate birthing resources and management," Poe said.

Concerns about loss of access don't just extend to physical health concerns or daily home services, but also to behavioral health services, on which 47% of Ohio adults on Medicaid rely, according to Kerstin Sjoberg, president and CEO of Disability Rights Ohio.

"If you don't have access to some sort of insurance like Medicaid, it's going to be almost impossible to get those services," Sjoberg said.

The state-level discussions come as federal budget reconciliation also touches on Medicaid funding as the Trump administration and Republicans in Congress attempt to slash federal spending by $880 billion over the next decade, particularly from public assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and Medicaid.

U.S. House Speaker Mike Johnson and other leaders have talked about "abuse" or "fraud" as sources of revenue loss for the country in public programs, something those who engage with users of programs like Medicaid push back on.

"In reality, Medicaid is one of the most cost-effective and widely used safety nets in the country," said the advocacy group Innovation Ohio in a call-to-action email over the congressional budget proposals. "If this bill becomes law, the result will be fewer people with health care, more families pushed into poverty and deeper inequality. Rural hospitals could shut down."

According to a study by the Commonwealth Fund, Ohio could be one of the hardest hit economies if Medicaid cuts at the federal level come to fruition, cuts that could mean 29% more Medicaid spending by states or cuts to other programs, like education, to offset the Medicaid losses.

Direct care providers

One thing that will have to be addressed whether or not the cuts are realized in the state and federal budgets is the workforce that helps those who use Medicaid for home care and other services.

Patalita said the word "crisis" has been used in talking about the shortage of direct care providers, similar to the shortage of child care workers needed to provide adequate access to that service.

"We've talked to people who have had to wait weeks to be able to receive services in the home, because there just aren't enough providers out there," Patalita said.

The Ability Center did a study after the previous state budget increased the reimbursement rate for direct care providers under the state Medicaid program. That study showed that while reimbursements rates and, for that matter, provider wages should go up, the solution to the shortage problem wouldn't come with just one answer.

"The direct care crisis is too complex of an issue for a single action to remedy," The Ability Center found.

The study identified three "major elements" of the shortage: high turnover rates, low hourly wages (lower than "many entry level positions in retail and food service," according to the study), and a lack of consistency in benefits.

"This failure by agencies to provide benefits adds to the worker shortage and forces those requiring home care to carry the burden of decreased access to care, especially those in rural areas," the study found.

Eliminating Medicaid funding, including the expansion group, will make life harder for those Ohioans who need the services, Sjoberg said, "but it will also make it necessary that the direct care workforce is supported in other ways."