Ohio Medicaid Submits Controversial Waiver Request

(July 1, 2016)  Ohio Medicaid has responded to a mandate from the Ohio General Assembly and submitted a waiver request to the federal government to operate the "Healthy Ohio Program."

During consideration of the state budget enacted June 30, 2015, the Ohio General Assembly included a provision that required the Ohio Department of Medicaid (ODM) to seek federal permission to mandate enrollment in a Health Savings Account for every non-disabled adult enrolled in Medicaid. After drafting the waiver and getting public comments from interested parties, ODM submitted the  Section 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS), June 30, 2016,

According to Section 1115 procedures, CMS must then post Ohio's waiver request online and invite public comment. There is no formal deadline for CMS to respond to the State for 1115 waiver decisions.

According to Medicaid Director John McCarthy the provisions in the budget were highly specific and did not allow the department any leeway to alter the proposal from legislative intent.  Questions remain as to how the department will proceed during conversations withe CMS and whether Ohio Medicaid will have any room to negotiate with the federal government during the process.  

Consumer organizations and health care advocates have been highly critical of the proposal. One study released earlier this year by a healthcare organization consulting firm, estimated the proposal could cost Ohio hospitals $2.5 billion over five years. Under the current Medicaid rules, those signing up for Medicaid are deemed eligible for coverage as soon as their application is submitted and providers can begin billing for services provided in the preceding three months. That provision is proposed to be eliminated, with Medicaid benefits instead beginning when the application is approved and the first payment made into the Health Savings Account.

The Center for Community Solutions (CCS) submitted comments to the Ohio Department of Medicaid during the public comment period. CCS outlined its concerns about "a complex and potentially costly proposal." Their detailed analysis is posted here: https://ccs.memberclicks.net/medicaid

Summary of the waiver

Waiver Request/Public Comments

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