One in four Ohioans rely on Medicaid to see a doctor or go to the hospital, including 1.3 million children. The federal budget contains limits and cuts to the program that Ohio would have to deal with. Advocates said that's why it's important that the state budget gives a lot of flexibility in dealing with Medicaid changes.
The budget Gov. Mike DeWine is looking over includes $43.2 billion in Medicaid spending, with $13.3 billion in state funds. DeWine said he's watching what’s happening in Congress with the bill President Trump is urging his fellow Republicans to pass. DeWine said the state and might have to adjust its budget, depending on what comes out of Washington.
"You have one part of Medicaid, 90% of it's paid for by the federal government,” DeWine said, referring to Medicaid expansion, which Ohio did under Republican former Gov. John Kasich in 2013. “We have other parts that's less, but it's always more than 50%.”
John Corlett, the state’s former Medicaid director, said lawmakers had initially proposed changes of their own but backed off in the end.
"I think they probably thought they were putting the Medicaid agency on a shorter leash, but not realizing the limitations that the controlling board had since Medicaid was expanded," Corlett said. "The legislature would have had to come back as an entire group to increase that appropriation authority. And I think there was very little interest among many legislators in doing that."
But the budget also allows for the Medicaid expansion population to lose coverage "immediately” if the federal drops below 90%. There are 761,756 Ohioans in the Medicaid expansion population as of this month. That trigger language was in DeWine’s initial budget and in the House and Senate versions. But Corlett said DeWine should strike the word “immediately” so the state can retain flexibility and time to make adjustments.
“The situation in Congress changes by the hour and I don’t know that anybody knows how it is going to end up," Corlett said.
Corlett said the bill Republicans in Congress are considering would cut nearly $1 trillion from the Medicaid program. And he said Ohio would be one of the states hit the hardest.
“That will definitely hurt the state of Ohio, and particularly hurt hospitals and community health centers and things that serve a large share of Medicaid enrollees," Corlett said.
A University of North Carolina at Chapel Hill study showed proposed Medicaid cuts at the federal level could lead to closure of nearly 400 hospitals nationwide. And Becker's Hospital Review reports eleven of them are in Ohio. Corlett said the hospitals that are most at risk are in rural areas of the state.
"I think particularly rural communities that have less infrastructure, that are more dependent on Medicare and Medicaid than other parts of the state than other institutions," Corlett said. "Their hospitals, their health clinics, their mental health agencies—it could all be in great jeopardy."
For his part, DeWine said he realizes it's important to have language that can help the state best respond to federal changes in the Medicaid program. But he said the state is limited.
"I will have an obligation. Unlike the federal government, we can't print money. We have to balance our budget. And so we hope that none of that happens. I made that very clear, and we'll see," DeWine said.
