The budget includes funding for more than 450,000 people newly enrolled in Medicaid expansion, which Gov. John Kasich pushed through a panel of lawmakers on the Controlling Board last year. But the budget also includes provisions to require about 100,000 adults making more than the federal poverty level to pay Medicaid premiums of around $20 a month. State Medicaid Director John McCarthy told lawmakers on the House Finance Committee that requiring a small monthly payment is an important for people who will eventually make enough money to start buying insurance from the federal marketplace or exchange.
"A person would be able to have those, see those premiums, understand what they meant, pay those premiums to maintain their coverage. That then is in essence, helping the person as they move up the income schedule and off of the program into affordable health care coverage in the exchange."
And McCarthy said he doesn't expect anyone to be dropped for lack of premium payment. But Democratic Rep. Dan Ramos of Lorain said he doubts that no one will be dropped or will drop out.
"It's not an issue of personal responsibility - it's an issue of 'do you have an extra $20 at the end of the month?'"
And Ramos noted a new study from the liberal-leaning think tank Policy Matters Ohio that showed the budget will raise taxes on the bottom 60% of Ohioans.
"…meaning, everyone eligible for Medicaid as well as everyone up to $58,000 a year."
Committee chair Ryan Smith (R-Gallipolis): "Let's get to the question, Representative."
"My question is, and I apologize, my question is how is it, how can, how are we going to lift people up and out of poverty when this budget's making it more expensive to be poor?"
The premiums plan doesn't require an okay from lawmakers. But it's unclear how Republicans in the legislature - many of whom had deep concerns about Medicaid expansion - view the premiums plan. However, some have raised concerns about how Medicaid expansion helps with recipients' mobility out of poverty. Mark Romanchuk is a Republican from Mansfield.
"I don't hear enough about how many people are coming off the system. The focus seems to be too much on how many people are signing up. I'd like to make sure that the focus is on how many people we're getting off the system and moving up and out."
Supporters of Medicaid expansion have said it's hard to talk and project about people coming out of the program since it just got started. But the director of the governor's Office of Health Transformation told lawmakers he sees positive trends developing. Greg Moody told the panel that though 451,000 Ohioans have enrolled in Medicaid expansion - which is paid totally by the federal government for now - enrollment is down for traditional Medicaid, which the state pays for in part. So overall, Moody said, Medicaid spending is under estimates.
"The best thing we can do to get people off Medicaid is to grow Ohio's economy and jobs and put more money in people's pocket. That really is the key. And when John says we're expecting kind of a stabilization of enrollment and possibly even a decline in enrollment, it's exactly tied to Ohio's economy improving."
And Moody said some people will be dropped from Medicaid not for doing anything wrong, but because their incomes have increased. But there are reports that half a million of the nearly 3 million Ohioans on Medicaid could lose their coverage in the next six months if they don't verify their incomes with the state. McCarthy said problems in reaching enrollees and issues with the state's website have been addressed, but added that verification of income is both a federal requirement and a personal responsibility. }
