by Chuck Hoven

(Plain Press, September 2018)     In an effort to educate the public about Medicaid expansion in Ohio and its benefits, and to convince the next governor of Ohio to continue participation in the program, Governor John Kasich’s administration is holding meetings throughout the State to present findings from a recent study showing the benefits of participating in Medicaid Expansion. On August 22, 2018, MetroHealth Medical Center hosted a conference, called Medicaid Works: Expansion Four Years Later, where State of Ohio officials presented findings from a 2018 assessment of the Medicaid Expansion program that started in 2014 as part of the Affordable Care Act.

The study, titled 2018 Ohio Medicaid Group VIII Assessment compiled by the Ohio Department of Medicaid, showed Medicaid Expansion reduced the uninsured rate in Ohio by half; helped individuals to find work or to keep their current jobs; and provided access to treatment for mental illness or substance abuse disorders.

Prior to the Medicaid Expansion in 2014, Medicaid in Ohio was available to certain select populations (parents and persons with a disability) with income less than 90% of the federal poverty rate. Ohio’s participation in the expansion in 2014, allowed individuals ages 19-64 with income up to 138% of the federal poverty rate to qualify for Medicaid. The Ohio Department of Medicaid said in 2014, under the program, the state expanded Medicaid coverage to an additional 700,000 Ohioans.

The Ohio Department of Medicaid calls the Medicaid Expansion “Group VIII”. It says that “Almost one fifth (17.5%) of Ohioans age 19-64 have participated in the Group VIII program since it began in 2014 (more than 1.26 million individuals).

Welcoming guests to the Medicaid Works conference at MetroHealth Medical Center on August 22, MetroHealth Chief Executive Officer Akram Boutros shared some stories about individuals who because of Medicaid expansion were able to get the health care they needed and return to work. Boutros said, Jeff, a man with no insurance, knew he had a spot on his lung, but waited until Medicaid expansion to get treatment for lung cancer. He told the story of Mary, a diabetic, who prior to Medicaid expansion couldn’t afford to take medication or visit the doctor. Boutros said with the advent of Medicaid Expansion, Mary found a primary care physician and got back to work. Boutros said Mary was now covered by her employers’ insurance and no longer needed Medicaid.

MetroHealth played an important role in Medicaid expansion in Ohio. Boutros noted the hospital piloted a Medicaid Waiver Program that proved that expanding Medicaid would save Medicaid and our county millions of dollars. Boutros thanked John Corlett, former Ohio Medicaid Director, for his role in creating the partnership with MetroHealth. Boutros also thanked Governor John Kasich for his bravery in going forward with the Medicaid expansion in Ohio. Boutros then introduced Ohio Department of Medicaid’s current director Barbara Sears and also thanked her for her role in continuing to advocate for the program today.

Director Sears praised John Corlett for his commitment to serve those in need in Ohio. She praised MetroHealth for stepping up and doing the waiver program which she said, “gave us an example that we could do statewide.”

Director Sears cited some statistics to demonstrate the impact of Medicaid expansion on people’s lives. She said 290,000 Medicaid expansion participants unenrolled in the program because they got a job or increased their income so they no longer qualified. She noted that 83.5% of employed enrollees said their Medicaid insurance made it easier for them to continue to work. 60% of unemployed enrollees said their Medicaid insurance made it easier for them to look for work. She said 15% more expansion enrollees are employed in 2018 when compared to 2016.

Medicaid expansion also contributes to family stability, said Sears. She said 57.6% of parents reported that having Medicaid made it easier for them to pay for food and shelter. 75.7% of enrollees reported having Medicaid made it easier for them to take care of their family. Sears said for example taking care of a family member on Medicare.

Sears then introduced a number of participants in the Medicaid expansion to share their stories with those in attendance.

Amber says she was a caregiver, who at age 24 was unable to work because of an illness and didn’t know what was wrong with her. Because of Medicaid expansion she was able to get insurance through Care Source and found out her problem was with her gall bladder and received needed medical attention. She is now working as a care giver with people with medical disabilities that need help with daily living. A mother of five, Amber says she just bought a house for her family.

Quanisha, who works for the nonprofit organization Welcome House, that serves individuals with intellectual and developmental disabilities, says Care Source insurance she received through Medicaid expansion helped her to get weight loss surgery. She said prior to the surgery she had high blood pressure and was diagnosed as pre-diabetic. She said, “I have three kids, so I couldn’t imagine having to pay for private insurance and take care of my family.”

John, said he received treatment for an opioid addiction from 2015 to 2017 that included both Medicine Assisted and Psycho-Social Treatment using United Health Care Insurance he received through Medicaid Expansion.  John said he had worked the same job for 25 years before being laid off and had no resume and no computer skills. He said United Health Care encouraged him to go to the library to get help putting a resume together and told him about a job fair. He said he took the resume he prepared at the library to the job fair and got a job offer for work in a Substance Abuse and Mental Health treatment facility.

Melanie said she was deaf in one ear since birth and couldn’t afford medical insurance. Now, thanks to her United Health Care insurance she received through Medicaid expansion, she had ear surgery and can now hear fully. Melanie said she once went to the emergency room because of pain and was told by a doctor that by retirement age she would be in a wheel chair because of knee and hip injuries she had sustained over the years in her work. She said, through Medicaid expansion she was able to get both knees and her hip replaced. Now, age 68, she says she was just offered part time employment. “I appreciate all the help I received from United Health Care,” she said.

La Sabryana testified on the importance of Medicaid Expansion to her. She said her health insurance through Medicaid Expansion was Paramount. She said prior to having health insurance she would get strep throat all the time. When she received health insurance she was able to get her tonsils out and no longer gets strep throat. She also has received help in paying for expensive asthma inhalers which allows her to have more money to spend on her son, age 3. She said Paramount is a good company which provides rides to her doctor appointments and sends nurses to the house.

Ohio Office of Budget and Management Director Tim Keen then talked about the financial costs and benefits of the Medicaid Expansion. Speaking of the Medicaid Expansion in Ohio, Keen said, “from my perspective it is both manageable and affordable.” He said there is a different reimbursement formula for the people in Medicaid Expansion from those on other parts of the Medicaid program. He said the State’s share of the cost of the non-expansion population is 37%, while by federal statute, the maximum the State of Ohio will pay toward the cost of Medicaid Expansion would be 10% starting in 2020 and into the future. However, some budgetary offsets that the State of Ohio can realize because of the Medicaid expansion reduce the effective rate it would pay to 3.2%.

Keen explained the millions of dollars the state would save in different categories in budgetary offsets resulting from Medicaid Expansion. He noted some of the categories – Medicaid paying for the cost of prisoners going to the hospital; drug rebates generated by the expansion; Managed Care Health Insuring Corporation members monthly assessments generated by the expansion; Health Insuring Corporation 1% insurance tax from expansion premiums; and Allowable Upper Payment Limit costs allocated to expansion program.

Keen’s numbers projected the overall cost of Medicaid expansion in the fiscal year 2021 would be 5.172 billion dollars. The State of Ohio’s initial share of that cost at the 10% rate would be $517.2 million. The federal government’s share would be $4.655 billion. Budgetary offsets would reduce the State of Ohio’s cost by $354.1 million, bringing the total net cost to the State of Ohio to $163.1 million, or 3.2% of the total cost of the program.

Keen estimated that the overall program would cost the State of Ohio $21 per person per month for a program that, Keen says, makes a “huge difference in peoples’ lives.”

Following Director Keen’s presentation, a number of people in the audience asked questions directed at Ohio Medicaid Director Barbara Sears.

A woman from First Year Cleveland asked if Medicaid could explore ways to improve housing conditions for pregnant moms. Director Sears agreed with the need to improve housing conditions for pregnant women and said that Health and Human Service agencies and community partners would have to be involved for such a program to make budgetary sense. MetroHealth Chief Executive Officer Akram Boutros, citing the high cost of providing medical services to homeless populations, said MetroHealth would be willing to participate in a pilot program to help with identifying pregnant women in need of housing.

Northeast Ohioans for Budget Legislation Equality (NOBLE) Organizer Akshai Singh asked if Medicaid could help people without transportation with the cost of a weekly or monthly bus pass so they could get to work or to managed care appointments. Director Sears suggested that the involvement of other agencies other than Medicaid would be necessary to provide such help. She mentioned the Office of Health Transformation, and Health and Human Services agencies. She noted that 14 different state of Ohio agencies are involved in moving people around. She suggested putting an umbrella over the transportation agencies “so no one gets left out.”

NOBLE member Gloria Aron asked about efforts in counties throughout the State of Ohio to let people know about Medicaid expansion so the number of uninsured in the State of Ohio continues to go down. Director Sears cited Medicaid rules restricting outreach and spending on letting people know what coverage is available. She said the program was dependent on local groups that can to do outreach to let people know what is available.

NOBLE member Diane Howard asked if something can be done about cuts in the Provide a Ride program. Director Sears said transportation services were not perfect in the State of Ohio. She said Ohio is looking to other states for how they provide transportation and their reimbursement models.

In closing, MetroHealth CEO Dr. Akram Boutros stressed the need to explain the benefits of saving Medicaid Expansion to the new administration when a new governor is elected. He said Medicaid Expansion helps people stay healthy and out of the hospital. Boutros said, “Reducing inpatient services is the only way to keep health care costs under control.”