Feds reject Ohio’s request to charge new Medicaid fees

COLUMBUS, Ohio (AP) — Federal regulators rejected Ohio’s plan to require Medicaid beneficiaries to pay a new monthly premium, saying Friday the proposal could lead to tens of thousands of low-income people losing health care coverage.

Under the proposed Healthy Ohio program, beneficiaries who fail to make the new payments would lose coverage and have to pay back any debt to re-enroll.

Federal officials told the state’s Medicaid director in a letter Friday that such a policy has not been authorized in any state and goes against the objectives of the federal-state health care program, which serves poor and disabled people.

Andrew Slavitt, acting administrator of the federal Centers for Medicare and Medicaid Services, said the move “could lead to a substantial population without access to affordable coverage.”

Slavitt pointed to state estimates that the policy could cause more than 125,000 people to lose coverage each year.

House Republicans in Ohio had inserted the proposed Medicaid premiums into the state budget last year as they sought to control costs in the $25.3 billion government program.

Ohio Medicaid director John McCarthy told legislative leaders Friday he would work with them to “ensure our mutual goal of promoting personal responsibility” is part of the Medicaid program. Democrats, health care advocates and others who were critical of the Healthy Ohio proposal praised the federal government’s rejection of it.

“The so-called Healthy Ohio Plan would have reversed our progress and threatened healthcare for the state’s poorest and often neediest population,” state Senate Democratic Leader Joe Schiavoni, of Boardman, said in a written statement.

About 3 million people, roughly a quarter of the state population, are on Medicaid. And the state estimated between 1.66 million and 1.84 million would be eligible for the Healthy Ohio program.

With the exception of pregnant women and people with no income, Healthy Ohio enrollees would contribute up to $8.25 per month to help cover their medical expenses. The payment would depend on income and would be capped at $99 annually. The money would go into a health savings account, along with an annual deposit from the state’s Medicaid agency. People would use the funds to help pay for doctor visits and other medical services.

Slavitt expressed concern about imposing the new charges, regardless of income, on roughly 600,000 adults who enrolled under an expansion of Medicaid, along with hundreds of thousands of low-income parents, foster care youth, and beneficiaries with breast and cervical cancer.

“CMS is concerned that these premiums would undermine access to coverage and the affordability of care, and do not support the objectives of the Medicaid program,” he wrote.

Republican Gov. John Kasich had pitched a different plan in his budget. It would have charged a monthly premium to far fewer people on Medicaid — about 100,000 non-disabled adults with incomes above 100 percent of the federal poverty level, an income of about $11,770 for individuals. The premium was about $20 per month.

Kasich and state lawmakers will now debate a new approach in the next two-year budget.

In neighboring Kentucky, federal regulators are taking public comments on a proposal to charge monthly premiums to the more than 400,000 people who got health coverage through an expanded Medicaid program.

The stakes are high. If the federal government does not approve the proposal to Kentucky Gov. Matt Bevin’s liking, the Republican has said he would repeal the state’s Medicaid expansion, causing more than 400,000 people to lose their health insurance.

The Kentucky plan would require people to pay monthly premiums of up to $15, penalizing people who don’t pay by locking them out of their insurance for up to six months. People would be required to get a job or volunteer at a charity to remain eligible for benefits, and they would be required to pay for services such as dental and vision care with credits earned through a rewards program.


Associated Press writer Adam Beam in Frankfort, Kentucky, contributed to this report.

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