The House-Senate Conference Committee for the state operating budget finalized its work on June 27 voting 4-2 along party lines to accept its report. Representing the House were Chair Ryan Smith, Vice Chair Scott Ryan, and Rankling Member Jack Cera. Representing the Senate were Chair Scott Oelslager, Vice Chair Gayle Manning, and Ranking Member Michael Skindell.
The Conference Committee had to reconcile over 600 differences between the Executive, House, and Senate versions of the bill. On June 28, both chambers of the Ohio General Assembly voted up to concur with the conference committee report. The governor signed the budget bill on June 30 but executed several line-item vetoes.
The final budget of the governor’s two-term administration proved to be one of the most challenging for the legislature and the administration due to the ongoing decline in
state revenue. With the initial announcement in March that state leaders would need to reduce budget expenditures by $800 million over the biennium. This total grew to nearly $1 billion by mid-June. As a result, most state agencies received 4-6% across-the-board cuts and Medicaid reimbursement rates for nursing homes and hospitals are frozen at January 1, 2017, levels.
Medicaid Budget Overview
The Medicaid budget, which makes up over 30% of the total, is always the most challenging and controversial portion of the budget. The need to reduce the state share of the general revenue fund (GRF) is challenging in Medicaid because every dollar you reduce in the state share has a larger impact on the 60% federal match. The political debate about Medicaid expansion that occurred at the Ohio Statehouse is a microcosm of the debate playing out at the federal level over the repeal and replacement of the Affordable Care Act.
Since the governor expanded Medicaid in Ohio for the working poor in 2014 without the support of the legislature, Medicaid expansion has been an ongoing point of contention. The administration originally estimated that no more that 440,000 would enroll in the Group VIII expansion. However, the current number of enrollees is over 700,000. With the federal match being reduced in 2020 from 100% to 90%, state legislators are worried that the state cannot afford their growing share of covering that population going forward. As a result, an amendment was included in the final version of the bill prohibiting any new eligible expansion enrollee from entering the program beginning in Sunday, January 1, 2018. With the governor’s belief in expansion to ensure Ohio’s working poor have access to health care, this provision was vetoed.
Opioid Funding
Ohio is also at the epicenter of the opioid epidemic, and some of the rural areas of the state have been hardest hit. The additional federal funding Ohio receives for Medicaid expansion has provided over $1 billion for Ohio to help combat the crisis. The House and Senate both identified $170 million in funding for additional efforts to fight the growing epidemic.