Ohio Medicaid eligibility requirements could have 18,000 losing coverage and cost counties millions

Ohio has joined a growing list of states that have requested permission to require certain Medicaid beneficiaries to work or complete other community-engagement activities as a condition of eligibility. The state estimates it would affect about 5 percent of the 700,000 people enrolled in the program as a result of Medicaid expansion. Ohio Medicaid requested federal approval on April 30.

The language of Ohio’s proposal is asking the federal government to approve a new work requirement for residents who gained Medicaid coverage under the expansion of the program under the Affordable Care Act. Those over 55, in school, training for a job, in drug or alcohol treatment, dealing with serious mental illness or severe health care needs would be exempt. Medicaid recipients who don’t meet the work requirements will be removed from the rolls.

Documents the state prepared show that 18,000 people a year would lose Medicaid health benefits if the work requirement, known as the 1115 Demonstration Waiver, is put in place.

Wendy Patton, senior policy director at Policy Matters Ohio, spoke at a public hearing in Cincinnati in February, saying many people who would qualify for an exemption will likely find it’s too much trouble.

“What might seem like a small errand to those of us fortunate enough to own a car or computer can be a time and money drain for a low-income person who depends on Medicaid. They are unlikely to own a computer to apply for the exemption online,” she said.

Hospitals across the state are also opposed to the proposal to impose work requirements for the Medicaid expansion population to maintain their health coverage, as reported in Modern Healthcare.

Report: Increased administrative burden and expense
With the waiver requirements, Cuyahoga County projected it would need to provide appraisals for nearly a third of the 96,085 individuals currently enrolled in Medicaid through the expansion. 

In an attempt to provide a more holistic representation of what this waiver would entail, the Center for Community Solutions has leveraged Cuyahoga County’s methodology and applied it statewide. The Center for Community Solutions estimates that county governments will need to provide new case management services to more than 200,000 Medicaid enrollees, at a cost of about $380 million over a five-year period, as a result of proposed eligibility requirements.  

Cuyahoga County will incur the largest cost in the state, more than $10.8 million if the proposal goes into effect. Franklin and Hamilton counties will follow with estimated costs of nearly $8 million and more than $6 million respectively.

Community Solutions has called the proposed changes in eligibility requirements “a complex, unfunded, legally questionable, mandate that fails to meet the essential purpose of Medicaid to provide medical assistance.” The proposal will increase the administrative costs of individual county governments by hundreds of millions of dollars.

Read the full Community Solutions report here and the Ohio Medicaid Proposed Work Requirements here.