Should some Ohio Medicaid recipients have to pay premiums?
Posted January 18, 2016 in Selected Press
Tens of thousands of low-income Ohioans could lose Medicaid coverage under a state plan to charge premiums and impose penalties on those who miss the payments, advocates for the poor warn.
Tens of thousands of low-income Ohioans could lose Medicaid coverage under a state plan to charge premiums and impose penalties on those who miss the payments, advocates for the poor warn.
"Poor people have trouble paying premiums because their choices are too hard. Rent, car repairs, utility bills. Even if they pay up and come back on (Medicaid), there is a disruption in care, and you may not take your medicine for a few months or get the treatment you need," said Wendy Patton, senior project director for Policy Matters, a progressive research group.
"It will work against the kind of good results we've seen with Medicaid expansion."
State officials plan to ask federal regulators later this year to allow premiums to be charged to nondisabled, working-age adults on Medicaid who have incomes of less than 138 percent of the federal poverty level, or about $16,200 a year. The requirement would affect more than 1 million of the 3 million Ohioans covered by the tax-funded health insurance.
Under the proposal, premiums -- the lesser of 2 percent of household income or $99 annually ($8.25 a month) -- would be paid into a modified health savings account. If premiums are 60 days late, Medicaid coverage is suspended until the money is paid; pregnant women are exempted.
The plan is subject to approval by the federal Centers for Medicare and Medicaid Services, as premiums are not allowed under current law. Federal officials have approved premiums in states such as Indiana, Oregon and Wisconsin, but none has guidelines as strict as what Ohio proposes.
Based on the experience in other states, advocates project that premiums could result in an enrollment decline of up to 15 percent and cause those with chronic conditions such as diabetes, hypertension or mental illness to go without care or medications.
"You could have someone with schizophrenia, or someone who has been recently hospitalized or who can't get their insulin, all sorts of circumstances," said Jon Honeck, a fellow with the Center for Community Solutions.
Supporters discounted the gloomy predictions.
"It's pretty ridiculous to say this will be an undue burden when premiums for most will be $1 or $2 a month," said state Rep. Jim Butler, R-Oakwood.
In the state budget passed last summer, the legislature directed Gov. John Kasich's administration to seek the federal waiver. The goals are to reduce overall Medicaid costs and encourage personal responsibility among beneficiaries.
Premiums, Butler said, are not to make the state money but to create an incentive for beneficiaries to get care in the proper setting and adopt a healthy lifestyle.
Health savings accounts would allow participants to earn points that are equal to dollars. For instance, a participant can earn points for quitting smoking or lowering his blood pressure or blood-sugar level. A preventive-care visit involves no points, but non-emergency use of a hospital emergency room costs points.
"Savings comes from people getting care in the right place and improved health outcomes," Butler said.
Ohio's $3 billion Medicaid program eats up the largest chunk of the state budget, and lawmakers have to rein in costs, said Rep. Robert Sprague, R-Findlay, another supporter of the plan.
The state's recent expansion of eligibility brought an additional 650,000 onto Medicaid rolls. The federal government is covering the additional expense for now, but next year, costs start to shift over to the state.
Sprague, referring to the proposed premium, said, "For 2 percent, they get a gold-plated medical card. The contribution is important. You become very price conscious when your own money is at stake."
Lawmakers also included in the budget a requirement that medical providers other than emergency rooms give all patients, in advance, a breakdown of costs, how much the insurers will pay and how much the patients will owe. That begins next year and does not require federal approval.
Patients "can shop (for medical care) just like we shop for cars or food," Sprague said.
Original Article: http://www.dispatch.com/content/stories/local/2016...