On Monday, February 4th, Governor John Kasich proposed that Ohio will expand Medicaid benefits to individuals earning up to 138% of the federal poverty level (FPL) (about $15,800 for an individual and $32,500 for a family of four). The Affordable Care Act (ACA) originally made such an expansion mandatory, but the Supreme Court’s ruling on the constitutionality of the ACA later made the expansion optional for states. States that choose to expand Medicaid will receive enhanced federal reimbursement—beginning at 100% and moving down to 90% in later years—for individuals newly eligible for Medicaid under the expansion. Governor Kasich also indicated that the Obama Administration is willing to engage in a conversation regarding affording flexibility to states in implementing a Medicaid expansion; specifically, allowing individuals earning between 100% and 138% of the FPL to receive subsidized coverage through the Health Insurance Exchange.
Expanding Medicaid will provide health coverage to many of the 1.5 million Ohioans with no way to pay for health care and no reliable access to medical treatments. According to the Ohio Alliance for Health Transformation, it is estimated that approximately 600,000 Ohioans will gain coverage under the expansion. Also, the expansion will result in more than $23.8 billion in additional federal funds flowing into Ohio’s economy through 2019. This money will support Ohio’s health care economy, including hospitals, health systems, and their employees. Importantly, the expansion will also mean that Ohio’s economy benefits from a healthier workforce.
According to the Governor’s Office of Health Transformation, the Governor is proposing new Medicaid cost sharing requirements for every adult earning more than 100% of the FPL. The state will require an $8 copayment for use of an emergency department for non-emergency conditions, $8 co-pays for nonpreferred drugs, and $3 co-pays for preferred drugs. Certain long-term maintenance drugs (such as insulin) will have no co-pay. Additionally, the Executive Budget includes an automatic opt out trigger so that if for any reason the federal government reduces its enhanced financial participation for expanded coverage, then the program for newly eligible groups shuts down.
Governor Kasich made this announcement as part of his 2014-2015 executive budget proposal. The matter, along with all other budget proposals, next moves to the General Assembly for debate.