State lawmakers ease off Medicaid freeze, for now

July 07--Hundreds of thousands of low-income Ohioans who have gained health insurance since 2014 dodged a bullet Thursday when state lawmakers decided not to put the brakes on Medicaid expansion -- at least for now.

Any move to prevent future enrollment in the government-funded health-insurance program for the poor and disabled could leave thousands of adults in Summit County without coverage. About 36,000 Summit County residents now qualify for Medicaid through expansion.

Gov. John Kasich had vetoed a plan by GOP lawmakers to freeze Medicaid expansion, which increased the maximum income to qualify for coverage. The Republican-controlled House voted Thursday morning to overturn 11 of Kasich's vetoes -- the expansion not being one of them.

How we got here

A provision of President Barack Obama's signature Affordable Care Act that many Republican governor's ignored, the expansion added more than 700,000 to Medicaid in Ohio, with federal funds paying for most of the additional cost. With fellow Republicans unwilling to accept the expansion, Gov. John Kasich bypassed the General Assembly in 2013 and went directly to the Ohio Controlling Board, a group six lawmakers who in this state can move funds around without legislative approval.

Throughout this year's biennial budget talks, the legislature has slowly chipped away at Medicaid expansion, which conservatives say puts Ohio on trajectory toward deficit spending.

In May, the Ohio House passed a version of the budget that revised eligibility requirements. Under that plan, new Medicaid enrollees through expansion would have had to have been 55 years or older; employed; in school or occupational training; attending drug or alcohol treatment; or diagnosed with "intensive health care needs."

The Senate went a step further in June, barring all new enrollment under Medicaid expansion starting in July 2018.

A last-minute compromise protected mental health or addiction patients from the new enrollment ban -- a move that allowed Republicans to roll back a program that accounts for 65 cents of every dollar spent to fight the opioid epidemic in Ohio, according to Kasich, who vetoed the freeze.

Who's at risk?

The expansion gave low-income adults without children access to Medicaid for the first time.

About 36,000 single adults in Summit County who make $16,642 or less a year (138 percent of the federal poverty level) have gained coverage through the Medicaid expansion.

In defending his veto, Kasich reminded Ohio lawmakers that Arizona implemented a similar freeze in 2011. Within 18 months the ranks of Arizonians newly covered by Medicaid fell by 70 percent.

In Ohio, Kasich says 500,000 would lose coverage if the legislature overrides his veto, which House Speaker Cliff Rosenberger (R-Clarksville) has said he would do if he can musters enough votes. For now, however, Rosenberger is putting off a vote to see if federal lawmakers repeal the Affordable Care Act.

To complicate matters, the governor says a Medicaid freeze with a carve out for the mentally ill and drug addicted may constitute a form of unlawful discrimination by denying everyone else access to a federally funded program.

How big is Medicaid?

Big.

In 2014, when the expansion gave insurance to another 4,600 residents in Summit County, Medicaid payments for medical services provided in Summit County hospitals and qualified health care centers totaled $768,46,3126.

Overall Medicaid spending in Summit County in 2016 topped $1 billion.

This is partly why health administrators have opposed libertarians and small-government conservatives in Columbus and the District of Columbia who have promised for seven years to dismantle the Affordable Care Act, often called Obamacare.

Today, there are 133,872 Summit County residents on Medicaid, according to Summit County Department of Job and Family Services, which process all Medicaid enrollment applications in the county.

Those covered by Medicaid include 70,815 parents and children; 27,225 in nursing homes or disabled but living at home or Medicare patients getting help with premiums; and 35,832 low-income adults who have no children but have become eligible through the expansion.

"They're single adults and they can get enrolled in any number of ways," said Pat Divoky, director at the job and family services agency.

Non-profit agencies help residents understand eligibility requirements and file application electronically, by mail or in-person. Oftentimes, patients are enrolled or re-enrolled while being treated in a hospital emergency room or at a health care provider that accepts Medicaid. Before the expansion, health care providers would treat these same people but take a loss because medical bills went unpaid. Charity care, it was called.

"They have to provide care," Divoky said of hospital's obligation to treat the public. "Where's the money going to come from? Are insurance rates [for other patients] going to go up? Who knows? The money has to come from somewhere."

How would the freeze work?

The Medicaid freeze, if revisited by Ohio lawmakers before the current General Assembly retires at the end of 2018, would not throw anyone currently on Medicaid off the program.

But any momentary lapse in coverage -- say, because a patient forgets to file necessary paperwork every six months -- could lead to a permanent loss of coverage.

The other concern among groups that advocate for giving health care to the poor is that a freeze would make low-income workers think twice before taking a job or pay raise that would inflate their income $1 above the 138 percent poverty-line threshold for coverage.

The Associated Press contributed to this report. Doug Livingston can be reached at 330-996-3792 or [email protected]. Follow on Twitter: @ABJDoug .

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