Medicaid expansion won’t see enrollment freeze — not yet anyway

Ohio Governor John Kasich (Cheriss May/NurPhoto/Zuma Press/TNS)
Ohio Governor John Kasich (Cheriss May/NurPhoto/Zuma Press/TNS)

Ohio House Republicans on Thursday backed off a threat to over ride Gov. John Kasich’s veto of a provision that would freeze enrollment in expanded Ohio Medicaid — a plan that the governor warned would lead to 500,000 people losing health care coverage.

House Speaker Cliff Rosenberger, R-Clarksville, said that he has the required 60 votes to override a veto but decided to wait to see what changes Congress makes to the Affordable Care Act and Medicaid, which is a state and federally funded health care program for low-income and disabled people.

An override vote may come this fall when legislators return to Columbus, Rosenberger said. They have until December 2018.

In 2013, Ohio expanded Medicaid coverage to single adults who make up to 138 percent of the federal poverty level. The expansion, which was a key piece of Obamacare, led to 725,000 additional people enrolling in Ohio Medicaid, which now covers 3 million.

The federal government picks up 95 percent of the tab for the expansion group and 63 percent for the others on Ohio Medicaid.

Conservative lawmakers, who view it as unsustainable, inserted into the budget bill a provision to freeze new enrollment under Medicaid expansion starting July 1, 2018. People who lose Medicaid eligibility because they land a higher paying job would not be allowed to re-qualify for the program after July 1, 2018, unless they were receiving drug treatment or mental health services.

Kasich vetoed that provision, warning that it would lead to lawsuits, trap people in poverty and result in 500,000 people losing Medicaid coverage.

Related: Hundreds rally at Statehouse to support Kasich's veto on Medicaid

The House did override 11 of Kasich’s 47 line-item budget bill vetoes. Most of the overrides related to authority over Medicaid.

For example, the House voted to hang onto authority to set nursing home reimbursement rates in law, keep oversight of Medicaid rate increases and delay requiring long-term care and behavioral health services to switch to a managed care model.

In a written statement, Kasich applauded lawmakers for holding off on the freeze but said some of the other veto overrides could put Medicaid coverage at risk.

“When these actions begin to impact health care access for Ohioans, those who supported them will bear responsibility. As the saying goes: if you break it, you own it,” Kasich said. “I call upon senators to carefully consider the consequences of their decisions and keep Ohio on the right path.”

Ohio counties and transit authorities landed a big win when the House voted 87-10 to override the governor’s veto of a provision that would generate $207 million for counties and public transit.

For six years, Ohio applied a sales tax to premiums charged by managed care organizations operating under Medicaid. The tax generated about $850 million for the state and $210 million for counties and transit authorities. But federal authorities ruled recently that Ohio can’t charge the managed care sales tax. The Kasich administration proposed in the budget a different fee that would replace $615 million a year for the state but left out the counties and transit authorities. The governor vetoed a plan to generate an additional $207 million in money for transit authorities and counties.

Ohio Budget Director Tim Keen says it’s risky to seek money for the counties and transit authorities, which have nothing to do with Medicaid, because federal officials make take it as an opportunity to limit or cancel federal approval of the fee that generates money for the state.

Keen and other administration officials warned that the House override votes put other elements of Medicaid in jeopardy. Greg Moody, Kasich’s director of health transformation, said that putting off plans to switch long term care to a managed care model will indefinitely push back savings that switch would generate.

The veto override items now move to the Ohio Senate for consideration, which needs 20 of the 33 senators to vote in favor of the overrides.

Senate Republican caucus spokesman John Fortney said GOP senators want to discuss all of Kasich’s 47 line item vetoes, including the 11 items the House overrode, before deciding the next step. A date for Senate override votes has yet to be determined, he said.

The Senate may only vote on the 11 items that the House already overrode.


Laura Bischoff in our Columbus Bureau has been following the state budget and its impact on you. Get her updates on Twitter @lbischoff