Ohio and the ACA’s Medicaid expansion

700,000 have gained coverage under expanded Medicaid

Where in your state to call or visit for Medicaid.How to apply

You can enroll online at HealthCare.gov or at the Ohio Benefits website.  You can also enroll by phone at 1-800-318-2596 or 800-324-8680.

Who is eligible in your state to get Medicaid?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.

  • By
  • healthinsurance.org contributor
  • January 5, 2017

Governor Kasich defends Medicaid expansion

Ohio accepted federal funding to expand Medicaid, and about 700,000 residents have gained coverage under the new eligibility rules. Ohio Governor John Kasich is not a fan of the Affordable Care Act (ACA), but he was one of the few Republican Governors who supported Medicaid expansion early in the process. Kasich has remained steadfastly supportive of Medicaid expansion, including during his presidential campaign in 2015/2016.

On January 3, Republican lawmakers began taking steps to repeal the ACA (via a reconciliation bill that would defund the law), but they have said that the full repeal/replace process could take as many as four years to implement (you can see ongoing details about this in our Repeal & Replace section).

The next day, Governor Kasich warned his fellow Republicans that repealing the ACA — without an equally robust replacement — could be disastrous. He pointed to the 700,000 Ohio residents who have gained coverage as a result of Medicaid expansion, and asked Republican lawmakers to explain exactly how those folks would continue to access coverage and healthcare without Medicaid expansion.

Kasich also noted that Medicaid expansion in Ohio has played a key role the state’s fight against opioid abuse, as people — who would otherwise have been uninsured — have been able to receive rehabilitation services covered by Medicaid.

Medicaid expansion in Ohio

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 paid the full cost through 2016, and under the current rules the federal government 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.

CMS denies request to make expansion more conservative

In September 2016, CMS denied a new waiver proposal from Ohio that would have required all enrollees (including those with income below the poverty line) to pay 2 percent of their income (but no more than $99 per year) into a health savings account. The problem for CMS was that the new guidelines would have resulted in people losing their Medicaid coverage if they got more than 60 days behind on their health savings account payments, and they would have had to get caught up on the payments in order to be able to re-enroll in the coverage.

The state noted that their estimate was that 125,000 people would lose coverage under the new guidelines, which was a non-starter for CMS — particularly because the state wanted to bar people from re-enrolling until they paid their overdue contributions. The feds have approved some states’ Medicaid waivers that require premiums or health savings account payments for people with income above the poverty level, but has not yet approved any states’ requests to condition continued eligibility for people under the poverty level upon payments to a health savings account.

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 enrollees, the federal government pays 100 percent of the costs through 2016. 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.

By mid-2016, the state’s portion of Medicaid spending was $428 million lower than projected.

Who is eligible for Ohio Medicaid?

Because Ohio has expanded Medicaid under the ACA, low-income adults without dependent children became 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. Ohio Medicaid puts out a report card each year, giving the managed care plans star ratings for various aspects of the coverage. The 2015 report is available here.

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 rivate plans. From the fall of 2013 to October 2016, total Medicaid and CHIP enrollment in Ohio grew by 26 percent. Net enrollment grew by nearly 635,000 people during that time frame.

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 67 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 has paid 100 percent of the cost of covering the population that’s newly-eligible population under the ACA’s Medicaid expansion guidelines. That percentage will decline to 95 percent 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.