Who is eligible
Adults are eligible with incomes up to 133% of poverty. Children are eligible with incomes up to 206% of poverty, and pregnant women are eligible with incomes up to 200% of poverty.
- healthinsurance.org contributor
- September 26, 2016
Medicaid expansion in Ohio
Ohio accepted federal funding to expand Medicaid, and about 454,000 residents are newly-eligible for expanded coverage. Ohio Governor John Kasich is not a fan of the ACA, but his support for Medicaid expansion made him one of the few Republican Governors who supported Medicaid expansion early in the process.
Kasich announced in early 2013 that the state would expand Medicaid using federal money to pay for the vast majority of the cost (the federal government pays the full cost through 2016, but will always pay at least 90 percent of the cost of covering the newly-eligible population).
Ohio lawmakers who were opposed to Medicaid expansion brought a lawsuit against the Kasich administration in an effort to block expansion, because the full legislature was not involved in the decision to expand Medicaid – it was done through the Controlling Board (six legislators who handle budget adjustments in the state – most states do not have something like this) after the Ohio House and Senate both voted to block Medicaid expansion and Kaisch vetoed their measure.
Ultimately, in late 2013, the Ohio Supreme Court ruled in favor of Governor Kasich, and Medicaid expansion took effect as scheduled in 2014. During the 2015 legislative session, lawmakers agreed to allow Medicaid expansion to continue, although the issue was just part of the budget agreement – there was no separate legislation on Medicaid expansion.
Good news for the budget
In welcome news for the state, a report in November 2014 indicated that over two years, it appeared that Medicaid would cost the state $470 million less than originally projected. And as of May 2015, Medicaid spending was $171 million under-budget. This is mainly because although more people than anticipated are enrolling in expanded Medicaid, fewer than anticipated are enrolling in the state’s traditional Medicaid (which covered children, pregnant women, and some very low-income parents with dependent children). A spike in enrollments in traditional Medicaid has been dubbed the “woodworker effect,” as people who were already eligible for Medicaid come “out of the woodwork.” It’s been seen in many states, but less so in Ohio.
For people who were already eligible under the old guidelines but hadn’t yet enrolled, the original state/federal expense split still remains. But for newly-eligible people, the federal government is currently paying 100 percent of the costs. Since fewer people have enrolled who qualified under the old guidelines, the state is currently spending less of its own money on Medicaid than it anticipated.
Originally, Ohio expected to have 377,000 newly-eligible people enrolled in Medicaid by June 2015. They later revised that total upwards by about 100,000 people. Total Medicaid/CHIP enrollment grew by 660,800 people between the end of 2013 and August 2015, including newly-eligible people as well as those who were previously eligible for coverage but not enrolled.
Who is eligible for Ohio Medicaid?
Because Ohio has expanded Medicaid under the ACA, low-income adults without dependent children are eligible for the first time in 2014. The following residents can enroll in Medicaid in Ohio (immigration rules apply):
- Adults with household income up to 133 percent of poverty (138 percent after the built-in 5 percent income disregard).
- Children with household income up to 206 percent of poverty.
- Pregnant women with household income up to 200 percent of poverty.
How do I enroll?
Enrollment in Medicaid is year-round; you do not need to wait for an open enrollment period if you’re eligible for Medicaid
- Ohio uses the federally-run insurance marketplace, so you can enroll through HealthCare.gov or use their call center at 1-800-318-2596.
- You can use the Ohio Medicaid (Ohio Benefits) website to enroll. You click on “check your eligibility” first, and if you’re eligible it will take you to the enrollment page.
- You can call or visit your county Department of Job and Family Services office (click on your county to see contact information).
Once you enroll in Ohio Medicaid, you’ll get a basic Medicaid (fee-for-service) ID card in the mail. Shortly after that, most new enrollees will receive a letter from Ohio Medicaid, asking them to select a Medicaid Managed Care program. There are five available: Buckeye Health Plan, CareSource, Molina Health Plan, Paramount Advantage, and UnitedHealthcare.
2014 enrollment numbers
During the first open enrollment period (October 2013 through April 2014) 156,899 Ohio residents were enrolled in Medicaid or CHIP (those who were newly-eligible under the expanded Medicaid guidelines were able to begin enrolling on December 9, 2013). But people can enroll directly through Ohio Medicaid as well, and enrollment in Medicaid and CHIP continue year-round; it’s not a limited enrollment window like private plans. From the fall of 2013 to July 2014, total Medicaid and CHIP enrollment in Ohio grew by 15.7 percent. Net enrollment grew by 367,003 people during that time frame. By September, the state Medicaid office was reporting that number had grown to 401,307 people.
Ohio Medicaid history
Ohio enacted Medicaid in July 1966, just six months after the earliest states to do so. The state implemented CHIP (Children’s Health Insurance Program) in 1998, initially covering children up to age 19 with household income up to 150 percent of poverty (that upper threshold was later increased to 200 percent of poverty).
The federal government pays nearly 63 percent of the cost of Ohio’s traditional Medicaid program, and the state pays the remainder. But the state gets a far better deal when it comes to Medicaid expansion: For 2014 – 2016, the federal government pays 100 percent of the cost of covering the population that’s newly-eligible population under the ACA’s Medicaid expansion guidelines. That percentage will gradually start to decline in 2017, and by 2020 the state will be paying 10 percent of the cost of covering the newly-eligible population.
In 2011, Governor Kasich created the Ohio Governor’s Office of Health Transformation to “modernize Medicaid, streamline health and human services programs, and pay for value.”
And although the ACA’s Medicaid expansion took effect in January 2014 in Ohio (as it did in all states that were early-adopters of Medicaid expansion), the state also used a Section 1115 waiver to expand Medicaid in 2013 to cover 30,000 non-elderly adults in Cuyahoga County. The eligibility threshold extended to 133 percent of the poverty level (the same as the ACA guidelines), so unless they had a change in income during the year, those early enrollees were able to transition to regular Medicaid expansion starting in 2014.