A Medicaid enrollment freeze included in the state budget approved on Wednesday by the Ohio legislature could cause more than 500,000 Ohioans to lose coverage under expanded Medicaid rules in place since 2014, according to Ohio Gov. John Kasich’s Office of Health Transformation.
The legislature voted along party lines for the $133 billion 2018-2019 budget, sending it to Kasich to consider. A balanced budget must be in place by July 1 and the budget uses cuts to close a $1.05 billion revenue shortfall.
The freeze impacts the expanded Medicaid coverage that provides health insurance to more than 725,500 Ohioans under the Affordable Care Act. The federal government pays the bulk of the cost. Without the changes in the budget the state is projected to spend $281.6 million on the expansion and receive $4.8 billion from the federal government in 2018, said Brittany Warner, spokeswoman for the Ohio Department of Medicaid.
An amendment would allow people with drug addictions or mental illness to continue to be eligible for Medicaid but all other new expansion enrollment would end as of July 1, 2018. It would require approval by the federal government before taking effect.
Kasich pushed through expansion by bypassing the state legislature in 2013 and instead getting approval from the state Controlling Board to allow people at up to 138 percent of the federal poverty level to get Medicaid.
The freeze “will result in significant coverage losses” and “could lock enrollees in poverty,” according to a memo by Kasich’s Office of Health Transformation.
The budget also requires that some Medicaid recipients - not just in the expansion program - pay a monthly premium, be employed, or attending some kind of training or substance abuse treatment.
Ohio House Democrats sent a letter to Kasich on Wednesday urging him to veto the enrollment freeze.
“We need to provide health care for Ohio’s families, all of Ohio’s families.” state Rep. Emilia Strong Sykes (D-Akron). “Without access to health care, lives will be lost and costs will rise. Ohio cannot afford to pay for the increased costs that will come by taking away people’s health care.”
A spokeswoman for Kasich would not say if he would veto the provision.
“We typically don’t weigh in on pending legislative proposals and the budget process is no different,” said Emmalee Kalmbach. “The governor said at his event today that once his office receives the bill the proposals will be reviewed and studied prior to any action taken.”
Sales taxes for counties and public transit
The budget now before the governor also gives counties and transit agencies relief from a multi-million dollar loss of sales tax revenue when the sales tax on Medicaid managed care plans ends on June 30.
The federal government required the state to quit charging the tax, and federal approval will also be needed for the fix.
But after a full-court press by county and transit officials, the budget proposal now includes 100 percent replacement of the $207 million in annual lost revenue for six years. It would require the state to seek a federal waiver allowing the state to use a franchise fee on the Medicaid managed care plans. The money would go to counties and transit authorities that experience a loss in sales tax revenues, said John Fortney, spokesman for the Ohio Senate Majority Caucus.
Mark Donaghy, executive director of the Greater Dayton Regional Transit Authority, said he was very pleased and hoped that the provision is signed by Kasich.
“Regional transit authorities across Ohio including Dayton were facing a significant revenue loss without the fix. Locally, it would be over $4 million annually and would result in significant service reductions and potential layoffs in order to balance our budget going forward,” Donaghy said.
Montgomery County would have lost more than $8 million in 2018.
“We’d like to say we are pleased, but we know the fight for this critical revenue is not over,” said Montgomery County Commission President Dan Foley. “We hope Governor Kasich will not veto this and he recognizes the devastating impact that this loss of revenue will have on the citizens and businesses of all Ohio counties. A veto would be the latest in a long list of actions aimed at crippling counties’ abilities to deliver quality services that are mandated by the State of Ohio.”
Class of 2018 graduation requirement changes
The budget also puts in place alternate graduation requirements for students in the Class of 2018 who don’t pass new state tests.
State Sen. Peggy Lehner, R-Kettering, said the change is designed to help students who may not be familiar with the new test, which is required for graduation.
Instead students can meet other criteria, including attendance, grade point average, community service and other options.
Legislators weigh in
Members broke along party lines in their opinion of the budget. Majority Republicans dominated the process and voted for it, Democrats made multiple failed efforts to provide more money to schools, local communities and the opioid fight and to pay for it by repealing a small business tax exemption that costs the state $1.1 billion a year in lost revenue.
Here are some of the reactions to the budget on Wednesday night:
State Rep. Niraj Antani, R-Miamisburg: “This is a fiscally conservative, balanced budget that holds the line on spending while supporting our schools and fights the opioid epidemic. This budget will help continue putting the Dayton region on a path to prosperity and I’m proud to support it.”
State Sen. Bill Beagle, R-Tipp City: “This was a challenging budget with a lot of hard choices to make….Additionally we were able to direct more resources to fight the opiate epidemic. Finally, I was pleased we were able to find a solution for our counties who will lose funding from the elimination of the Medicaid managed care sales tax, though I’m disappointed we couldn’t do more for our municipalities.”
State Rep. Rick Perales, R-Beavercreek: “I’m pleased that even with a challenging budget climate we were able to secure BRAC-related funds for infrastructure at Wright-Patt, as well as additional funding for the Federal Research Network. Both are outstanding investments in our military assets as well as the state. We are also able to invest substantially in the fight against opioids and heroin, and continue to put a solid investment in education.”
State Rep. Jim Butler, R-Oakwood: “I am pleased that Governor Kasich’s initial proposal to repeal the Healthcare Price Transparency Law was removed from the budget. Even better is the fact that the current law remains in effect, so hopefully someday soon patients will have a right under the law to receive an upfront, good-faith estimate of the cost of their non-emergency health care services.”
House Democratic Leader Fred Strahorn, D-Dayton: “While the rest of America is recovering from the global recession, six years of Republican mismanagement have held us back from solving real problems like attracting better-paying jobs, reducing health care costs, and strengthening our children’s schools.”
Ohio Senate President Larry Obhof, R-Medina: “I think overall we all agree that this bill is a good bill for the State of Ohio, that despite challenging financial circumstances, we were able to continue to invest in the state’s priorities and I think this is going to help keep Ohio on the right track.”
Ohio House Speaker Clifford A. Rosenberger, R-Clarksville: “Today, the House approved a responsible budget plan that prioritizes our state’s greatest needs, such as fighting the drug crisis, funding schools and supporting our communities.”
State Senator Michael J. Skindell, D-Lakewood: “Republicans could have taken a balanced approach to the budget, but instead they focused on funding cuts that will mean fewer dollars for our schools, colleges, and local communities. “