Sources: Health Policy Institute of Ohio, Community Solutions, and The Columbus Dispatch
The 2016-17 state budget bill requires the Ohio Department of Medicaid to apply to the Centers for Medicare and Medicaid Services (CMS) for a waiver to create the Healthy Ohio Program – a program that would require non-disabled, working-age adults on Medicaid who have incomes of less than 138% of the federal poverty level (about $16,200 per year) to pay premiums into a modified health savings account. The proposal would affect more than 1 million Ohioans currently covered under Medicaid expansion.
Ohio Academy of Family Physicians Executive Vice President Ann Spicer is a member of the Health Policy Institute of Ohio Access Policy Advisory Workgroup that met on January 20 with Ohio Medicaid Director John McCarthy about the Healthy Ohio waiver. State officials will be applying for a waiver later this year after a required public comment period. The budget language is drafted in a way that gives Medicaid little discretion to shape the program or waiver application.
So in keeping with the dictates of the statute, state officials will ask federal regulators later this year to allow premiums to be charged to nondisabled, working-age adults on Medicaid who have incomes of less than 138% of the federal poverty level, or about $16,200 a year. (Source: “Should Some Ohio Medicaid Recipients Have to Pay Premiums” – The Columbus Dispatch, January 18, 2016).
Under the proposal, premiums — the lesser of 2% of household income or $99 annually ($8.25 a month) — would be paid into a modified health savings account. If premiums are 60 days late, Medicaid coverage is suspended until the money is paid; pregnant women are exempted.
Since premiums are not allowed under current law, the plan is subject to approval by CMS; however, premiums have been a feature of Medicaid waiver programs in other states. Federal officials have approved premiums in Indiana, Oregon, and Wisconsin, but none has guidelines as strict as what Ohio proposes. In the early 2000s, Oregon increased premiums for adults in its Medicaid program under 100% of the federal poverty level through a waiver. After implementation of the premium increased, enrollment dropped by nearly 50% and the biggest drop in enrollment was among enrollees with the lowest income.
Supporters of the Healthy Ohio program say that Ohio’s program was modeled on one that was approved in Indiana however there are multiple differences in the Ohio and Indiana plans. The primary difference is that the Indiana plan decreased the number of uninsured and increased the number of individuals with Medicaid coverage. The Ohio program would do the exact opposite – increase the number of uninsured and decrease the number of individuals with Medicaid coverage as well as increase Medicaid administrative costs and complexity. The Healthy Ohio program includes a lock-out period for failure to pay premiums, has no requirement to cover all essential health benefits and institutes a cap on yearly and lifetime expenses (the last two features are specifically disallowed by the Affordable Care Act).
According to an analysis by the Center for Community Solutions in Cleveland, research suggests that the cost of administering nominal premiums for Medicaid enrollees outweighs the value of the premiums.
The OAFP will continue to monitor development of the Healthy Ohio Program waiver and will participate in public comment periods.