Ohio will seek a waiver from the CMS allowing the state to drop adult beneficiaries who don't pay into a health savings account, regardless of their income.
Previously, legislators had proposed that Medicaid beneficiaries with incomes between 100% and 138% of poverty be required to put 2% of their family income into a health savings account, or lose coverage. The final, joint version signed by Republican Gov. John Kasich requires beneficiaries over the age of 18, except pregnant women, to annually contribute the lesser of 2% of their income or $99 into a health savings account, even if their income is below 100% of the poverty level.
The Kasich administration had warned legislators that no one other state has been allowed to drop Medicaid enrollees with incomes below federal poverty line for not having paid monthly fees or contributions to a health savings account. Officials say they will draft the waiver request in the coming months and seek public input, though they acknowledged they could get pushback from the federal government.
Ohio's Medicaid program serves more than 2.9 million residents, which is about a quarter of the state's population. Officials with the Governor's office and the Ohio Department of Medicaid didn't immediately respond to a request for comment on Monday.
Previous proposals in Ohio were similar to Indiana's conservative waiver program, which imposes premiums on beneficiaries with incomes between 100% and 138% of poverty and locks them out of coverage for six months if they miss payments.
Advocates have called the waiver proposal draconian, and say that it threatens the state's progress in Medicaid expansion. The program will be costly to administer and will require the state to contract with a vendor to track beneficiaries, said Cathy Levine, co-chair of Ohio Consumers for Health Coverage, a coalition of consumer interest groups.
“This is ideologically driven from a legislature that didn't want to do the Medicaid expansion in the first place and is lax in understanding or compassion for the health needs of low-income people,” Levine said.
When low-income individuals are asked to pay even modest amounts for their healthcare, they tend to lose coverage, Levine said. She's worried that the program will cause too many people to lose access to primary care and management of chronic conditions.
“I am hopeful the federal government will say a flat 'no' to this waiver, because our Medicaid expansion has been in effect for going on a year and a half and it's working as it was intended to,” Levine said. “This is just going to move us in the wrong direction.”