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Ohio Legislators May Take Control of Medicaid Expansion from Governor

Mary K. Caffrey
House Republicans say that Medicaid takes up too much of the state's budget for them not to have more say in who receives it. They also included budget language calling for Medicaid officials to ask CMS to allow healthcare savings accounts for almost all beneficiaries.
Medicaid expansion will continue in Ohio for now, after members the House of Representatives approved a version of the state budget last week. But Republican John Kasich’s ability to control Medicaid may not last, as lawmakers tucked in a provision granting legislators, not the governor, the power to decide who qualifies for the program in the future.

The Columbus Dispatch reports that Republican lawmakers added the provision in direct response to Kasich’s 2013 decision to expand Medicaid. “It’s such a big piece of the budget that we feel we should have some say in approval,” House Finance Committee Chairman Ryan Smith told the newspaper.

Kasich is among the handful of Republican governors who have expanded Medicaid, and he did so without help from a Democratic-controlled legislators. Like Democrat Steve Beshear in Kentucky, Kasich relied on a state constitution that granted him broad executive authority to expand Medicaid as permitted under the Affordable Care Act, even if the legislature was not on board.

Ohio’s expansion of the healthcare program for the poor to those earning up to 138% of the federal poverty line has helped some major institutions, including the Cleveland Clinic. In early April, the medical giant reported a 40% drop in charity care in 2014 from 2013, attributable to the number of clients who now had insurance coverage.

Conservative lawmakers continued to voice frustration at Medicaid expansion during budget deliberations but ultimately declined to cut funding. Several floor speakers reminded voters that it was Kasich who extended health coverage to more than 500,000 low-income adults, bringing enrollment to about 3 million.

Ohio House lawmakers also included budget language that asks state Medicaid officials to seek a CMS waiver that would require beneficiaries to make contributions to health savings accounts, which would cover costs of their care. All Medicaid clients would need accounts, even children, regardless of income level—only seniors, the blind and disabled would be exempt. Kasich has called for beneficiaries in the expansion population to have such accounts, but the requirement would only apply to adults. 

 
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