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Spurned by Ohio lawmakers, Kasich set to deliver on Medicaid expansion

October 17, 2013
by Dennis Grantham, Editor-in-Chief
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Governor's surprise expansion request to Ohio Controlling Board likely to win, say critics
Ohio's state flag

On October 9, at about the same time that Ohio’s Medicaid program received CMS approval on state plan amendments that would simplify its complex eligibility rules, the administration of Ohio's Republican Governor, John Kasich, leaked word that the Governor, who was denied the support of Ohio's Republican-dominated General Assembly for the Medicaid expansion earlier this year, plans to enact it anyway.

As reported by the Associated Press and a number of news organizations, Ohio's Medicaid expansion would be accomplished through a request to the Ohio Controlling Board, a seven-member panel (three state senators, three representatives, and an appointed head) that is empowered to make adjustments in the state's budget. The Governor's request, which was submitted on Friday, October 11, asks the board to adjust the state's biennial budget to permit the use of federal funds to expand health benefits to Ohioans under terms of health reforms that begin January 1, 2014.

While the maneuver is unusual for a budget adjustment of this size, even staunch Medicaid expansion opponents concede that there's nothing, short a negative vote by the Controlling Board, that can stop it. Kasich can see the expansion through with a simple, four-vote majority on the panel, which is likely to consider the expansion request at its October 21 meeting in Columbus, reports the Columbus Dispatch.

An affirmative vote by the board would allow the expansion to proceed through to the end of Ohio's current biennial budget, which ends June 30, 2015. Once underway, the expansion would be difficult to stop politically in future state budgets without risking bankruptcy to Ohio's Medicaid system, an action that is prohibited by state law.

The word from Columbus is that Kasich already has three sure votes, two from panel Democrats, plus that of his appointee, and that a political deal will be cut to get at least one of the board's four Republican members to go his way.

Medicaid expansion would make approximately 270,000 more Ohioans eligible for Medicaid health insurance coverage and bring the state up to $2.6 billion in additional federal Medicaid  funding over the next two years to insure them. Under the Affordable Care Act, the federal government has pledged to pay 100 percent of the cost of the recipients added through terms of the Medicaid expansion through 2016, then step down its support to 90 percent of those costs for 2020 and thereafter.

Coverage for Ohio's current Medicaid recipients, nearly 2 million according to the Kaiser Family Foundation, is funded with a split of about 63 percent federal funds, called the "federal medical assistance percentage," or FMAP, while the state picks up the remaining 37 percent. 

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