House weighs Medicaid vote

April 28--COLUMBUS -- The Ohio House of Representatives plans to vote next week on a two-year budget that would make it tougher to qualify for Medicaid coverage under Gov. John Kasich's still-controversial expansion of it.

Currently, those earning less than 138 percent of the federal poverty level, approaching $34,000 annually for a family of four, may qualify.

Under a provision added by House Republicans, the Kasich administration would be required to seek authorization from the federal government to impose work requirements on recipients to qualify or remain in the program.

Exceptions would include those who are 55 or older, have "intensive health care needs," are in school, or are participating in substance abuse treatment.

Medicaid, in general, is the biggest piece of the state budget and, therefore, a likely target for cuts. It is federal-state health insurance viewed as a last resort for the poor, disabled, and infirm.

Republican legislative leaders have agreed to cut $800 million from Mr. Kasich's $66.9 billion budget proposal for the next two years because tax collections have failed to keep pace with expectations.

"There's obviously a lot of additional spending in that area, and that's where you'll see a lot of restrained growth," Ohio Rep. Ryan Smith (R., Bidwell), chairman of the House Finance Committee, said this week.

Steve Wagner, executive director of the Universal Health Care Action Network, estimated that some 80,000 out of the roughly 700,000 people in the program could be forced out.

"This works against trying to get people employed," Mr. Wagner said. "If people can't stay healthy, they have a hard time getting a job. It's counterproductive to making sure we have a healthy work force. You have to be in an alcohol or drug addiction program. What if you're on a waiting list?"

All of this assumes the expansion survives continuing efforts by President Trump and the Republican-controlled Congress to repeal and replace the federal Affordable Care Act that pays for it.

A report issued Thursday by the Center for Community Solutions suggested that rural counties are more likely to be affected by proposed state and federal changes. As a percentage of county population, rural Ohioans are more likely to receive coverage under the broader Medicaid program.

The study noted, however, that urban Lucas County ranks 13th in the state in terms of the percentage of its population enrolled in broader Medicaid -- 33.4 percent. The state average is 24.9 percent.

No other urban county ranks among the top 22.

Facing opposition from fellow Republicans who control the General Assembly, Mr. Kasich convinced a quasi-legislative budgetary panel, the Ohio Controlling Board, in 2013 to accept billions in federal funds to expand Medicaid eligibility.

While never directly approving the expansion, the General Assembly has since quietly appropriated enough money to cover Ohio's share. The federal government currently pays 95 percent of the cost, but that will decline to 90 percent in 2020 and after.

"At this time, we are still reviewing the changes made in the [amended] bill and will continue working with the House during the budget process," said Brittany Warner, spokesman for the Department of Medicaid.

Two years ago, lawmakers forced the Kasich administration to seek federal approval from the federal Centers for Medicare and Medicaid Services for the Healthy Ohio Plan, which would have required participants to pay premiums or risk losing coverage. The waiver was rejected.

Mr. Kasich has proposed asking for a federal waiver for a separate plan requiring income-based premiums of about $20 per month for childless, nonpregnant adults.

Contact Jim Provance at: [email protected] or 614-221-0496.

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