Ohio's Kasich Lets Legislators Avoid Vote on Medicaid Expansion

Governor John Kasich changed eligibility rules to add 450,000 Ohioans to Medicaid last year. The budget he presents to the Legislature will be silent on reauthorizing those rules, but will call for changes to find savings elsewhere in the program.

Ohio Governor John Kasich regards Medicaid expansion as a priority. He knows many of fellow Republican legislators don’t share that view. But rather than set up a battle over the issue, Kasich has make a budget move that will table the issue for now, while leaving 450,000 newly eligible residents on Medicaid.

The Columbus Dispatch reports this morning that Kasich will unveil a 2-year budget proposal that is silent on reauthorizing the expanded eligibility criteria that took effect last year. The governor also seeks to find efficiencies in the program through expanded use of managed care, and in fact has already taken steps in this area.

Kasich Administration officials believe things can stay just as they are unless the Legislature proactively moves to change the criteria or cut Medicaid funding. But even that second step might not remove individual Ohioans from the rolls; the governor could instead cut payments to hospitals and institutions. Lawmakers know this, and despite the opposition many have to expanding eligibility, many will accept the choice of avoiding a direct vote on the issue.

Senate President Keith Faber told the Dispatch, “I don’t support Medicaid expansion. But it expanded, and now we have to make it work.”

Ohio’s use of managed care to find savings has had mixed success, with some longtime providers reporting payment interruptions earlier this year. Reports suggest the next step will be to bring managed care to the mental health services sector, which is proving a popular area for states seeking savings. Iowa unveiled plans to expand managed care in this area recently.

Such changes would require federal approval. Kasich has also discussed increasing “personal responsibility.” In some states with Republican leadership, lawmakers have sought requirements that Medicaid recipients show they have a job or are seeking one. CMS previously rejected this request of former Pennsylvania Tom Corbett, but there have been signs the Obama Administration may have softened on this point, as North Carolina and Alabama have weighed expansion.

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