Medicaid/Medicare

400k Ohioans may lose Medicaid benefits this summer, report estimates

Hundreds of thousands of Ohioans may lose Medicaid coverage this summer when the federal government's COVID-19 emergency declaration ends, according to a new national report (Source: “More than 400,000 Ohioans at risk of losing Medicaid coverage this summer as COVID emergency ends,” Cincinnati Enquirer, April 19).

Around 3.3 million Ohioans were enrolled in Medicaid this fiscal year as of February, an increase from around 2.8 million from 2020. Under the declaration, Ohio and other states were unable to take people off Medicaid, even if they become ineligible. A new Commonwealth Fund report estimates that as many as 400,000 Ohioans could lose their coverage at the conclusion of the public health emergency.

Last week, HPIO released a new fact sheet, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic,” which details enrollment and spending trends in Ohio Medicaid due to the COVID-19 pandemic.

HPIO is also hosting a free online forum May 3, titled “What’s on the Horizon for Ohio’s Medicaid Program? Innovation, Equity and Unwinding the Public Health Emergency.”


New HPIO fact sheet explores Medicaid enrollment, spending trends during pandemic

The Health Policy Institute of Ohio has released a new fact sheet, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”
 
Since the COVID-19 pandemic began in March 2020, enrollment in, spending on and federal funding for Ohio Medicaid have increased significantly. Drawing from the foundational information provided in HPIO’s Ohio Medicaid Basics 2021 policy brief, this fact sheet provides information on:

  • Changes to the Medicaid program due to the COVID-19 pandemic
  • Enrollment changes during the COVID-19 pandemic
  • Ohio Medicaid spending during the COVID-19 pandemic

“Ohio policymakers must be agile in their response to new challenges facing Medicaid enrollees as the COVID-19 pandemic continues, including the end of the (public health emergency) and potential loss of Medicaid eligibility for tens of thousands of Ohioans,” the fact sheet concludes. “State policymakers and other stakeholders must also balance the benefits of the Medicaid program with budgetary and administrative challenges to improve health, achieve equity and promote sustainable healthcare spending in Ohio.”


CMS proposes adding Health Equity Index to Medicare Advantage, Part D star ratings

The annual rule governing Medicare Advantage and Part D is putting a focus on health equity, the Biden administration announced earlier this month (Source: “CMS puts focus on health equity in Medicare Advantage, Part D Advance Notice,” Fierce Healthcare, Feb. 3).

The Centers for Medicare and Medicaid Services (CMS) issued its proposed Advance Notice for Medicare Advantage and Part D in 2023, and in the regulation the agency proposes updating the MA and Part D star ratings to account for how well a plan tackles health equity.

CMS is seeking comment specifically on a potential quality measure for the star ratings that would assess how often plans are screening for common social needs such as food insecurity, housing insecurity and transportation challenges.

CMS Deputy Administrator and Center for Medicare Director Meena Seshamani, M.D., said in a statement that the proposed Heath Equity Index aims to enhance transparency around how MA plans are treating "our most vulnerable beneficiaries" as well as encourage improvements in their care.


Ohio Medicaid announces care management organizations for OhioRISE program

The Ohio Department of Medicaid announced this week the 20 organizations that would launch OhioRISE, a new Medicaid program for children with severe behavioral and mental problems (Source: “Parents have given up custody to get care for children with severe needs. Ohio Medicaid is closer to ending that,” Columbus Dispatch, Feb. 17).

OhioRISE, short for Resilience through Integrated Systems and Excellence, is scheduled to roll out in July with the goal of addressing situations where parents are at risk of giving up custody of their children to the state in order to get the required, unaffordable mental health and residential care needed by a child with severe behavioral and mental health problems. 

Aetna will be the health insurance company overseeing the program, which the department expects to cover up to 60,000 children by the end of the first year. The organizations, called care management entities, will be responsible for coordinating care for a child: Bringing together schools, behavioral health providers, juvenile services and other systems to provide help for complex needs. 

The $1 billion program is partly paid for by savings from other planned Medicaid reforms, such as centralized credentialing and billing systems. Around $19.5 million will be given to the entities to help them start up.


States brace for Medicaid redetermination following end of health emergency

The Biden administration and state officials are bracing for a great unwinding: Millions of people losing their Medicaid benefits when the pandemic health emergency ends (Source: “Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead,” Kaiser Health News, Feb. 14).

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare and Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. Congress gave states billions of dollars to support the coverage requirement. But the money will dry up soon after the end of the public emergency — and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.


Ohio to push for reinstatement of Medicaid work requirement

Ohio will appeal a move by the Biden administration to rescind federal approval of a work requirement that the state wants to use to determine Medicaid eligibility, Gov. Mike DeWine announced Thursday (Source: “Ohio seeks to reinstate Medicaid work requirement in appeal to Biden administration move,” Columbus Dispatch, Sept. 9).

Attorney General Dave Yost filed a notice of appeal with the Centers for Medicare & Medicaid Services weeks after the agency withdrew its approval for the "community engagement" requirement. The measure would require all new adult group beneficiaries under 50 years old to complete 80 hours per month of employment, education or job skills training.   

Federal officials approved Ohio's requirement under former President Trump in 2019, but the COVID-19 pandemic prevented it from going into effect this year. DeWine and other Republicans say it's necessary to encourage self-sufficiency and relieve the burden on taxpayers.


COVID vaccination rates for Medicaid enrollees lag overall population

Medicaid enrollees are getting vaccinated against COVID-19 at far lower rates than the overall population as states search for the best strategies to improve access to the shots and persuade those who remain hesitant (Source: “Medicaid vaccination rates founder as states struggle to immunize their poorest residents,” Kaiser Health News via Ohio Capital Journal, Sept. 1).

Efforts by state Medicaid agencies and the private health plans that most states pay to cover their low-income residents have been challenging amid a lack of access to state data about which members are immunized. The problems reflect the decentralized nature of the health program, funded largely by the federal government but managed by the states.

It also points to the difficulty in getting the message to Medicaid populations about the importance of the COVID vaccines and the challenges they face getting care.


Biden administration revokes permission for Ohio Medicaid work requirements

The federal Centers for Medicare and Medicaid Services told the Ohio Department of Medicaid this week that it cannot proceed with its plans to require some people on the health coverage program to work to keep their coverage (Source: “Biden administration nixes Ohio’s Medicaid work requirements,” Cleveland Plain Dealer, Aug. 11).

In a 23-page letter, sent to the state on Tuesday, CMS says that work requirements do not “ promote the statutory objectives of Medicaid” because they would likely result in thousands of people losing coverage.

This is a change from the administration of former President Donald Trump, which had approved the state’s work requirements program in 2019. The Ohio Department of Medicaid was directed to submit a work requirement program by the Ohio General Assembly in the 2017 budget bill.

Work requirements were supposed to begin Jan. 1, but were postponed because of the coronavirus pandemic.


Ohio Senate pushes for another re-bid of Medicaid managed care contracts

After a more-than-two-year effort to overhaul Ohio's Medicaid managed care system, state senators are asking for what could amount to a redo of the whole thing (Source: “Ohio announced huge contracts for companies to handle Medicaid managed care. Lawmakers want a redo,” Columbus Dispatch, June 3).

The state in April had chosen six companies to handle Medicaid for most Ohio enrollees. But at least two of the companies who lost out on contracts filed complaints against the Ohio Department of Medicaid.

Those complaints have turned into legislative action.

Senate Republicans on Tuesday inserted language into the state budget bill requiring the state to complete a new procurement process, with the stipulation that new contracts with Medicaid managed care organizations must include those based in Ohio.


HPIO releases Ohio Medicaid Basics 2021

Earlier this week, the Health Policy Institute of Ohio released Ohio Medicaid Basics 2021.

Medicaid pays for healthcare services for more than three million Ohioans with low incomes, including almost 1.3 million children. Federal and state expenditures on Medicaid accounted for about 38% of Ohio’s budget in state fiscal year 2020. And $1 out of every $6 spent on health care in the U.S. is spent on Medicaid.

As the payor of healthcare services for more than a quarter of all Ohioans, Medicaid can be leveraged to make large-scale policy changes that impact the health of residents. 

Released to coincide with the state biennial budget, Ohio Medicaid Basics provides a foundational summary of the state-federal program. The 2021 edition provides an overview of Ohio Medicaid eligibility, enrollment and financing. The brief also includes an update of significant changes to Ohio Medicaid in the past year.

HPIO has created Medicaid Basics every two years since 2005.