Archive for category Health/Medicaid
Ohio At A Cross Roads: Medicaid Expansion
The Ohio General Assembly and Governor Kasich are at odds over Medicaid expansion as anticipated by the Affordable Care Act.
The Governor, a conservative Republican, included a Medicaid expansion in the state budget for all Ohioans with incomes up to 138% of the federal poverty level. This is the right thing to do for Ohioans who are now uninsured and cannot obtain the care they need to become, or remain, healthy. It is also the right thing to do to help Ohioans become more employable so they can be self-sufficient and stable. It is also the right thing to do for the state’s economy and budget.
Expanding access to health care to address the needs of the uninsured and to help Ohioans become self-sufficient and stable is important, but the last point about the state’s economy and budget is why every member of the Ohio General Assembly should support the Medicaid expansion.
The Medicaid expansion draws federal dollars into Ohio. The Governor projects that $13 billion dollars of federal funding would come to Ohio by 2020. Other projections are as high as $20 billion. In any case, a huge amount of money would circulate and generate additional economic growth in Ohio’s towns, cities and counties.
The Medicaid expansion fills a $400 million hole in the state budget because it off sets costs for mental health, corrections, drug and alcohol treatment and other services.
Read more about the impact of a Medicaid expansion in Ohio, on the Office of Health Transformation’s website, http://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=vDu4XgXYGm0%3d&tabid=136
The expansion has the overwhelming support of the public, stakeholders and others. Click here to see what stakeholders and editorial boards have said about the expansion.
What they are saying about extending Medicaid coverage: Stakeholders and Editorials
The House removed the expansion from the budget it passed and has said that it will consider an expansion in the fall of 2013. The Senate President has announced that he would support a separate bill to explore whether to expand Medicaid, but it is unclear when such a bill might be introduced, how quickly it would move, and whether the Senate would make it a priority.
In the meantime, the clock ticks on and Ohioans may not get the care they need and deserve, and the state will lose billions of dollars of federal funding, just when the state needs to increase its economic activity and growth. Standing in the way of expanding Medicaid is bad for the state and bad for Ohioans.
The Governor is right. Ohio needs to expand Medicaid now to provide care for its residents and to strengthen our economy. As concerned Ohioans, we should all first, contact the Governor to thank him for fighting for Medicaid, second, contact our legislators to ask them to do what is right for Ohio and Ohioans, expand our Medicaid program now and, third, tell our friends and neighbors to do the same.
The Medicaid expansion currently being debated in the state budget would improve the health, safety and stability of Ohioans and Ohio families.
People who have access to health care are healthier. They get more appropriate preventive care and avoid emergency-room visits and heath crises. Many low-wage workers do not have access to employment-based health insurance, and they cannot afford to buy private insurance.
Families and individuals with access to health care are safer. They can get the health care they need, including immunizations and prescription medications, to avoid health risks and address chronic conditions.
Families and individuals with access to health care are more stable. Medical debt was a factor in 62 percent of the 38,000 bankruptcy filings in Ohio in 2012. Medical debts also play a significant role in home foreclosures. Access to health care would significantly reduce the number of bankruptcies and home foreclosures so that more Ohioans could remain economically stable and independent.
Debt also is a factor in domestic violence. Reducing medical debt would lessen family stress and domestic violence, keeping more families intact and stable.
Access to health care also will make Ohioans more employable, increasing their financial and social stability.
The Medicaid expansion would provide a helping hand to Ohio, Ohioans and Ohio families. It would keep Ohioans healthy, safe and stable. It is the right decision for Ohio and all of our residents.
– EUGENE R. KING
Ohio Poverty Law Center
Will OWF face the same fate as DMA?
Is Ohio setting up OWF for cuts in the next budget?
In 2003, enrollment in the state Disability Medical Assistance Program (DMA) was about 32,000 people. DMA was a state funded program that provided basic medical care for Ohioans who were disabled or dependent on prescription medications and had very low incomes, no more than $115 per month. This was also a crucial program for Ohioans because in addition to basic health care, it provided a means to obtain medical tests and documentation to support disabilities in the Aged Blind and Disabled (ABD) Medicaid application process. Through a series of funding cuts and enrollment freezes, the Ohio Department of Job and Family Services shrunk the DMA program to a few thousand people in 2008 and finally eliminated it altogether in 2009 because the enrolled population could not justify the cost of administration.
In 2012, Ohio is again shrinking a crucial benefits program. Ohio Works First (OWF), Ohio’s version of the federal Temporary Assistance for Needy Families program has lost 24% of its regular adult enrollees in the 12 months between June 2011 (217,203 adults) and May 2012 (164,221). This loss of adult enrollment can be attributed to a number of factors, including: time limits; sanctions; more aggressive enforcement of work requirements; aging out of dependent children; transportation; and a wide range of perceived and real barriers at the state and county agencies. Whatever the reasons, OWF is shrinking dramatically during an economic downturn in which record numbers of people are unemployed and child poverty is growing. OWF is shrinking dramatically in the midst of a now four year recession that should be triggering record expansions in the program. (Look to the Medicaid program in Ohio that serves much the same population. In the same time period, it has grown significantly.) OWF is now, or will soon be, a program primarily for children, despite the continuing needs of their parents. The impact on families of smaller assistance groups and reduced monthly benefits will be catastrophic.
Counties have experienced cuts to their administrative funds in the last two state budgets. These funding cuts make it harder for counties to meet the state and federal requirements that they provide services to help OWF recipients become self-sufficient. Lower OWF enrollment could be used to justify further cuts to the counties which will make it ever harder to serve their low-income residents? Lower OWF enrollments could also justify cuts in other programs such as food assistance and child care? Other low-income programs could also be targeted for cuts based on lower OWF numbers. Lower OWF numbers can define away the problem of poverty in Ohio.
Unlike DMA, Ohio will not eliminate the OWF program, but it is clear that it wants to shrink it, despite the growing levels of poverty and the desperate need for assistance. A smaller OWF program will be less helpful to low-income Ohioans and not help them to get out of poverty and become self-sufficient. The state is intentionally shrinking the safety net. Every month more Ohioans are losing that protection.
Governor Kasich signed the Midterm Budget Review (MBR) on June 11. A number of human services issues got a lot of attention during the process, some good and some bad.
1. Post Sanction Reenrollment into OWF got more difficult
RC Section 5107.05 was amended to add stricter requirements to the reenrollment requirements for Ohio Works First (OWF) recipients who have been subject to sanctions. The changes include:
- the situations in which a sanctioned recipient must enter into a new self-sufficiency contract to resume participation in OWF;
- the completion of all components of the self-sufficiency contract rather than the willingness to come into full compliance; and,
- in many cases the assistance group must also reapply for OWF in order to resume participation in OWF.
Based on legal aid experience across the state, most sanctions are triggered by a failure to meet the work requirements or other work readiness issues. This is often due to an absence of meaningful work, and/or transportation, child care, and scheduling issues that are a fact of life for low-income people. This appears to be another block in the wall of barriers that the state is creating to reduce its rolls in order to meet the federal work participation requirements. OWF enrollment has dropped 24% in the twelve month period ending in May 2012.
2. Medicaid Given Authority for Waivers
The MBR granted authority to the Medicaid Director at ODJFS to apply for any needed additional waivers and amendments to the state Medicaid plan to implement the proposed 1115 Medicaid waiver aimed at streamlining the Medicaid eligibility process. We support these proposals and believe that they will help more Ohioans to qualify for Medicaid more quickly. See the announcement from the Office of Health Transformations on the 1115 waiver.
3. Drug testing was out, then in, then back out, but it will be back
The bill did not include any provisions requiring drug testing of applicants or recipients for public benefits programs. An amendment was offered late in the Senate process, but that amendment was withdrawn within 24 hours in response to testimony by advocates that the Chair said raised questions that would require further consideration.
4. Nursing Homes lost a windfall
The MBR included a provision that would have rolled over $30 million in Medicaid funds from 2012 – 2013 for increased payments to nursing facilities. The Governor vetoed this provision, stating that, “No new data has been presented to justify those changes, demonstrate a need, or explain the rationale for this specific amount. . . The Nursing Facility Reimbursement Subcommittee of the Unified Long Term Services and Supports Advisory Work Group established in HB 153 is the appropriate venue for considering modifications to the nursing facility reimbursement formula.”
The Governor also vetoed $1.5 million for the Aging in Place Pilot Project aimed at funding home improvements to allow individuals to stay in their homes instead of moving to a nursing facility. The veto message stated that this program “. . . duplicates existing programs, however as nearly $18 million is currently spent annually on such efforts. . . “