Ohio Health Policy Review

General Assembly considering Medicaid legislation outside of budget plan

Following the Ohio Senate’s decision to not include Medicaid expansion in its budget plan, members of the General Assembly are turning their attention to separate bills that address reforming the Medicaid program (source: “Bills may pave way to expand Medicaid,” Toledo Blade, June 14, 2013).

Identical bills introduced in the House and Senate this week address cost-containment and work-development, but do not address expansion. The bills would tie growth in the Medicaid program to the medical component of the Consumer Price Index and would require a new 10-member, legislative Joint Medicaid Oversight Committee to work to keep costs within those goals.

Hearings also will begin next week on a separate compromise proposed by Rep. Barbara Sears (R., Monclova) that would link some similar initiatives to control costs in Medicaid, but also includes the eligibility expansion Gov. Kasich included in his budget proposal. 

Poll: 63 percent of Ohioans support Medicaid expansion

A newly released Ohio Health Issues Poll found that 63 percent of Ohio adults support Medicaid expansion in the state (Source: “Clear majority of Ohioans support Medicaid expansion,” Health Foundation of Greater Cincinnati press release, June 14, 2013).

OHIP, funded by The Health Foundation of Greater Cincinnati asked, “Generally speaking, do you favor or oppose expanding Medicaid to provide health insurance to more low-income uninsured adults?”

“The majority of Ohio adults, crossing all Ohio demographic groups and geographies tracked by OHIP, favored expansion,” according to the press release.

A majority of registered voters in Ohio favored expansion, although support for the expansion was divided along partisan lines. More than 8 in 10 Democrats (82  percent) support expansion and more than half of Independents support it (52 percent). However, more than half of Republicans (55 percent) are opposed to Medicaid expansion.

The 2013 Ohio Health Issues Poll (OHIP) was conducted May 19-June 2, 2013, by the Institute for Policy Research at the University of Cincinnati. A random sample of 866 adults from throughout Ohio was interviewed by by landline telephones and cell phones.

[Full disclosure: The Health Foundation of Greater Cincinnati provides financial support to the Health Policy Institute of Ohio] 

ODI announces proposed rates for plans on exchange

The Ohio Department of Insurance announced yesterday that 14 insurance companies have submitted proposed rates on 214 plans that could be available next year on Ohio’s federally run health insurance exchange (Source: “Insurance prices still unclear,” Columbus Dispatch, June 7, 2013).

The rates represent an average 88 percent increase in costs for health insurance companies, but it remains unclear exactly how those increased costs will translate to higher premiums. The rates are still under review by ODI and must be approved and submited by July 31 to the federal government for a final review and certification for sale on the exchange.

“This information provides a partial look at what the cost of insurance coverage may look like in 2014, but doesn’t equate to the premiums that will be charged as market competition may influence rates and subsidies will be provided to those under 400 percent of the federal poverty level,” said Amy Rohling McGee, president of the nonpartisan Health Policy Institute of Ohio.

ODI officials said they expect the proposed rates will translate to significant rate increases for consumers in the individual market. People that are young and healthy are expected to see the highest rate increases, while conversely, those who are older or have a preexisting health condition will likely see lower rates. 

The number of Ohio consumers who buy individual health coverage directly from insurers is expected to double between 2010 and 2017, from about 3 percent of the state's population, or 350,000 Ohioans in 2010, to about 6 percent of the population, or 735,000 Ohioans, in 2017.

Survey: Commercial insurers consider payment reform ‘major priority’

A national survey of commercial health plans found that 82 percent consider payment reform a “major priority” and nearly 60 percent predict that more than half of their business will be supported by value-based payment models in the next five years (Source: “Value-based payment models expected to reach tipping point by 2018, study finds,” Healthcare IT News, May 13, 2013).

The study, titled Health Plan Readiness to Operationalize New Payment Models, was conducted by health information network Availity and examines the migration of commercial plans from a fee-for-service model to value-based models. 

Advocates for veterans push for Medicaid expansion

Advocates for Ohio veterans urged the state to expand Medicaid this week, estimating that Medicaid expansion would help approximately 26,000 Ohio veterans who are not eligible for free care from the U.S. Department of Veterans Affairs  (Source: “Veterans advocates want Ohio to expand Medicaid,” AP via Delphos Herald, June 3, 2013).

Medicaid expansion "will help thousands of Ohio veterans and their families, who right now have no health insurance, simply due to when they served in the military," said retired Air Force Col. Tom Moe, director of the Ohio Department of Veterans Service.

Advocates estimate 1 in 4 uninsured Ohioans live with mental illness

A new paper released this week by the National Alliance on Mental Illness concludes that nearly a quarter of the estimated 1.5 million uninsured Ohioans live with mental illness and would benefit from an expansion of Medicaid eligibility (Source: “Ohio projected to lose $53B if it rejects Medicaid expansion,” Dayton Daily News, May 31, 2013)

Only two states — Nebraska and Minnesota — have a higher percentage of uninsured adults living with mental illness than Ohio, according to the report, which found the rate in both of those states exceeds 30 percent. 

Feds push simplified Medicaid enrollment

Earlier this month the Obama administration informed states that they could simplify enrollment in Medicaid to handle the anticipated increase in enrollees next year (Source: "Feds Make It Easier For States To Enroll Poor Under Health Law,” Kaiser Health News, May 18, 2013).

In a letter to state officials, federal Medicaid Director Cindy Mann laid out several ways states might streamline enrollment for adults, including using data people have already submitted to qualify for foods stamps – a practice that a few states permit for children. 

States may also allow adults to stay enrolled in the program for up to a year, even if their income changes, the letter said.

In Ohio, the Governor’s Office of Health Transformation has “initiated an eligibility modernization project to simplify client eligibility based on income, streamline state and local responsibility for eligibility determination, and modernize eligibility systems technology,” according to the OHT's website. 

Ohio House to consider new Medicaid expansion bill

Republican Rep. Barbara Sears of Lucas County introduced a bill this week that would extend Medicaid eligibility to Ohioans earning up to 138 percent of the federal poverty level, a plan that is similar to what Gov. Kasich included in his budget proposal. (Source: “Ohio House bill would expand Medicaid to cover state's working poor,” Cleveland Plain Dealer, May 22, 2013).

Sears' legislation also requires the state to study reforms that could lower costs and reduce uncompensated care. And it calls for job training services meant to help Medicaid recipients find better jobs that have health coverage of their own.

"Ohio's Medicaid system has made substantial improvements over the past few years and this legislation furthers that effort," Sears said in a statement. "By providing a ladder up and out of poverty through quality care, we are allowing for citizens to achieve greater self sufficiency and creating a healthier Ohio."

GOP Senate leaders leaning toward Medicaid reform, away from expansion

Republican Senate leaders are indicating that they are interested in pushing a series of reforms to Medicaid, but seem less likely to support Gov. Kasich’s plan to expand the program (Source: “Legislators mull Medicaid changes rather than expansion,” Columbus, Dispatch, May 17, 2013).

“It’s always better to create a path for short-term benefits with long-term incentives to become self-sufficient,” said Senate President Keith Faber, R-Celina, in a meeting with editors and reporters at the Columbus Dispatch.

Among ideas being considered by legislative leaders are time limits and work requirements for Medicaid enrollees, as well as the potential of moving thousands of pregnant women, disabled workers and children from Medicaid to coverage obtain through the health insurance exchange.

All of the material from the Ohio Medicaid Expansion Study, a partnership between HPIO, the Ohio State University, the Urban Institute and Regional Economic Models, Inc., as well as additional Medicaid resources from HPIO, is available at www.hpio.net/medicaid

Study: Medicaid ‘churn’ increases hospitalizations, costs

Researchers at George Washington University have found that Medicaid enrollees coming on and off of the program leads to more hospitalizations and higher costs for patients (Source: “Study: Medicaid 'churn' bad for patients,” The Hill, May 10, 2013).

According to the Association for Community Affiliated Plans study of Medicaid “churn” –- or when beneficiaries move on and off the rolls because of small variations in income –- a beneficiary enrolled consistently for 12 months pays $333 in medical bills per month, on average. Patients enrolled for six months paid $469 per month, and those enrolled for one month paid $625.