Initial Medicaid Implementation: Ohio initially began their Medicaid program in July of 1966. At the onset of the implementation of Medicaid, Ohio did not offer the option of medically needy coverage. The state did not expand their program as much as many other states and didn’t see as many problems with the cost of the program. In the first year of the program, the state spent approximately $50 million providing services to approximately 300,000 beneficiaries. According to a GAO report, over the next 11 years the costs increased 10 fold and eligibility increased 143 percent while Medicaid costs nationwide increased 1,500 percent, although that increase is likely because of more states taking up the program.
Key Medicaid Political Issues: In 1986 Ohio created a program called the PASSPORT program. This program allows Ohio residents over the age of 60 to learn about their long-term care options and provides in home care. The state has eliminated the waitlist for their various home care programs and has transferred thousands of people from nursing facilities to the home over the last decade. Ohio has been at the brunt of the opioid epidemic that has put a strain on the state’s Medicaid program and health care resources.
Medicaid Expansion Implementation: Ohio expanded Medicaid with applications being made available in October of 2013 and coverage beginning in January of 2014. The governor utilized an existing flexibility that allowed then governor John Kasich to expand Medicaid using a budget control board made up of six legislators that oversee changes to the state’s budget. This gained opposition from the Republican controlled legislature who voted to block the Medicaid expansion that was vetoed by the governor and they raised questions of the legality of the move and filed a lawsuit against the governor. In 2013 the Ohio Supreme Court sided with the governor and the expansion was allowed to continue. Since the initial decision to expand, the continuation of the program has been a consistent point of conflict in the legislature. Prior to the expansion of Medicaid, Ohio received an 1115 waiver to expand coverage to approximately 30,000 non-elderly adults in Cuyahoga County in 2013 to up to 138 percent of the poverty level. In 2018 Ohio sent a waiver request to the federal government to add work requirements for their Medicaid expansion populations. The waiver gained national attention because of the manner in which counties with high proportions of African Americans would be subject to the waiver while rural counties with predominately white populations would be exempt. Medicaid expansion is popular in Ohio with only 14% of the population wanting to end the expansion.
General facts about Ohio Medicaid:
Medicaid program name: Medicaid
CHIP Program name: Healthy Start
Separate or combined CHIP: Combination
Medicaid Enrollment: 2.7 million (2018 estimate)
Total Medicaid Spending: $23.2 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 22% (estimate)
Share of Children covered by Medicaid: 40% (estimate)
Share of Medicaid that is Children and Adults: 79%
Share of Spending on Elderly and people with disabilities: 59%
Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)
Expansion state: Yes
Number of people in expansion: 711,000 (estimate)
Work Requirement: Under Review