HHS Listens to Public, Sticks to Principles & Rejects Ohio Medicaid Waiver

The public spoke and HHS listened. That is my takeaway from today’s rejection of the state of Ohio’s Medicaid Section 1115 waiver proposal that would have created more barriers to needed health care for Medicaid beneficiaries and result in more uninsured Ohioans.

Governor Kasich has staunchly defended Ohio’s Medicaid expansion which has contributed to a sharp reduction in Ohio’s uninsured rate. These changes were not his ideas. They emanated from opponents of expansion in the legislature and were enacted last year as part of the state’s operating budget.

As Jesse Cross-Call with the Center on Budget and Policy Priorities pointed out in an earlier blog, 99 percent of those commenting on the Ohio Medicaid waiver proposal during the state public comment period opposed it. Dubbed “Healthy Ohio”, the waiver adopted many of the harmful concepts included in Indiana’s complex and controversial Medicaid expansion waiver and made them worse. If approved, the misnamed “Healthy Ohio” would have made it harder for low-income Ohioans to maintain their coverage and access needed health care – not only the more than 600,000 adults who have gained coverage as a result of expansion – but also those very low income parents and pregnant women that were already eligible for Medicaid before 2014.

No state has been allowed to charge enforceable premiums to people with income below the poverty line, and I am glad to see that HHS has held firmly to that principle by rejecting Healthy Ohio. Under the waiver proposal the state submitted, all nondisabled adults ages 18 to 64 (including parents eligible for Medicaid prior to health reform) would have been required to make monthly contributions to an account. People who missed their premium payments would be disenrolled from coverage and would be barred from re-enrolling until they made back payments. Research shows that charging premiums to low-income individuals deters them from enrolling in health coverage and raises the uninsured rate.

Ohio also sought to waive the fair hearing requirement for those who lost or were never enrolled in coverage due to nonpayment. This provision has never been waived and is protected by the due process clause of the Constitution, according to the Kaiser Commission on Medicaid and the Uninsured’s factsheet on the Ohio proposal.

Ohio also failed to show how the waiver request fulfilled the requirement that demonstration waivers increase and strengthen overall coverage of low-income individuals. The state estimated that enrollment under Healthy Ohio would be 9 percent lower than if its Medicaid program continued as is so it’s fairly obvious that the demonstration waiver would not have increased and strengthened coverage for low-income Ohioans.

CCF was among those urging HHS to “reject Ohio’s proposal and send a clear signal to other states that proposals that would lead to coverage losses and make it more difficult for beneficiaries to obtain needed care are unacceptable”. HHS has stated in the past that it will not approve waivers that limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities or impose premiums or cost-sharing at levels that prevent low-income individuals from accessing care. I am glad HHS stuck to its principles and listened to the public’s concerns.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.