Ohio hospitals could lose billions if the CMS approves a Medicaid waiver requested by Gov. John Kasich's administration.
The Republican governor and presidential candidate wants to move Ohio to a more conservative approach to Medicaid expansion, allowing the program to drop adult beneficiaries who don't pay into a health savings account, regardless of their income.
Another controversial provision would eliminate 90-day retroactive coverage for Medicaid beneficiaries. That could be particularly painful for hospitals, according to Cleveland-based Human Arc, a consulting firm that advises hospitals in the state on spending and eligibility issues. The change could cost hospitals as much as $2.5 billion over the course of the five-year waiver, the firm estimated.
Under current Ohio Medicaid rules, eligibility begins the day an application is submitted, assuming the applicant is ultimately deemed to qualify for benefits. Providers can also bill for services provided in the preceding three months, assuming the patient met eligibility rules during that time, said John Corlett, a former Ohio Medicaid director and executive director of the Center for Community Solutions, a not-for-profit, nonpartisan think tank.
Under the Healthy Ohio waiver, eligibility would not begin until an application is actually approved for Medicaid and the person enrolls in a managed-care plan and makes a first payment into a health savings account.
This change would mean the program would not pay an estimated 350,000 to 380,000 medical claims, adding up to $470 million to $510 million a year in lost revenue for providers, according to the Human Arc analysis.
The chances that the CMS will go along with the plan are unclear. The agency approved a similar request for Healthy Indiana Plan 2.0, which is the template for Healthy Ohio. New Hampshire received a conditional one-year waiver to eliminate retroactive eligibility, but the state was required to submit data showing no coverage gap would occur as a result. The state submitted the data in December, but a final decision has not been announced. A spokesperson for New Hampshire's Medicaid agency did not respond to a request for comment.
Arkansas officials have also expressed interest in a retroactive coverage waiver, but HHS Secretary Sylvia Burwell appeared to oppose the idea in a January 2016 letter to the state's Republican governor, Asa Hutchinson.
“Retroactive coverage is especially important when issues with a state's eligibility and enrollment systems lead to unnecessary gaps in coverage,” Burwell said. “We recognize the recent improvements Arkansas has made to its eligibility and enrollment system, but significant additional progress is needed to ensure that all eligible individuals are enrolled in Medicaid in a timely manner.”
Ohio's waiver request is posted for comment. The deadline for responses is May 13. The state wants to launch the new version of Medicaid expansion outlined in the waiver by Jan. 1, 2018.