Sources: Health Policy Institute of Ohio, Community Solutions, and WLWT Cincinnati
Ohio Department of Medicaid Director John McCarthy announced that the state of Ohio will release the Medicaid waiver language for public comment on Friday, April 15. 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.
The state of Ohio public comment period will last for 30 days until Friday, May 13, after which the application will be submitted to CMS. If approved, the waiver would affect 1 million Ohioans by requiring that they establish health savings accounts (HSAs) and pay annually to maintain their Medicaid coverage.
The budget language was drafted in a way that gives Ohio Medicaid little discretion to shape the program or waiver application. So in keeping with the dictates of the statute, state officials will be asking federal regulators 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.
Under the proposal, premiums — the lesser of 2% of household income or $99 annually ($8.25 a month) — would be paid into a modified HSA. 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 have 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 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 Ohio Academy of Family Physicians is preparing comments for submission during the public comment period.
- Community Solutions analysis
- “Should Some Ohio Medicaid Recipients Have to Pay Premiums?” The Columbus Dispatch, January 18, 2016).