BEYOND THE NUMBERS
Ohio’s request to the federal government to change how most adult Medicaid beneficiaries get their health coverage would — as the state admits — cause hundreds of thousands of people to lose that coverage. Similar to proposals in Kentucky and Arizona, the core elements of Ohio’s plan threaten the state’s progress in covering low-income residents under health reform’s Medicaid expansion:
- Premiums for people with little or no income. Ohio proposes to charge a monthly premium to most adult beneficiaries, no matter their income. Extensive research shows charging premiums to the poor makes it less likely they will enroll in coverage and get needed care. That’s why Ohio estimates enrollment will be 9 percent lower under its proposal than without it.
- Disenrollment for missing premium payments. Beneficiaries who miss premium payments for two straight months would lose their coverage and couldn’t re-enroll until they made any missed payments. While the federal government has allowed some states to charge premiums to their Medicaid expansion populations, it hasn’t allowed any state to disenroll people with incomes below the poverty line who miss payments.
Ohio, like Arizona and Kentucky, proposes to set up accounts for beneficiaries modeled on a health savings account (HSA), into which they would deposit their premiums. Those payments, in turn, would help cover their co-payments when they access care. This idea is borrowed from the waiver Indiana used to expand Medicaid. But there’s mounting evidence that Indiana has had trouble implementing the core provisions of its plan, so federal officials shouldn’t allow other states to adopt Indiana’s approach until state and federal evaluations of it that are now underway are completed.
Ohio received nearly 1,000 public comments on its proposal, the vast majority of which opposed the proposed premiums and expressed concern that beneficiaries would have trouble getting necessary health care. Only 1 percent of commenters supported the plan. Yet Ohio made no significant changes to the proposal before submitting it to the Department of Health and Human Services (HHS).
In evaluating state requests for waivers from federal Medicaid rules, HHS examines whether they would expand and strengthen coverage among a state’s low-income residents. Like the proposals from Kentucky and Arizona, Ohio’s proposal fails this test.