Medicaid in Action

Ohioans are reaping the rewards of the state’s Medicaid expansion as lawmakers mull funding going forward

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click to enlarge After living without health insurance for several months, Charles McClinon was able to get on Medicaid after the expansion went into effect. McClinon has epilepsy.
After living without health insurance for several months, Charles McClinon was able to get on Medicaid after the expansion went into effect. McClinon has epilepsy.

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harles McClinon was in a tough spot in 2013 when he lost his health coverage. The 52-year-old Cincinnati native, who has epilepsy, had returned to school in Chicago when the medication he took for his seizures started affecting his short-term memory. 

He applied through his student health insurance for an operation that would have helped him control the seizures, but the company denied him because of his pre-existing condition. And then it dropped his policy.

Left without health insurance for the first time in his life, McClinon was still having seizures and running out of options — he was unable to afford private insurance and couldn’t get a job with benefits.

“I started failing school, too,” McClinon says. “I’ve always been able to do well in school. I’ve never ever had a problem with finding a job.”

Advocates for Ohio’s Medicaid expansion — which went into effect in 2014 — say the federal program is a relief for people like McClinon to get the care they need. But opponents of expanding the program in the state, including many Republican lawmakers, see it as a potential drag on the state’s budget in coming years, as the state will need to start footing some of the bill by the end of this year. Opponents now worry about the share Ohio will have to cover beginning in the next fiscal year.   

“I don’t support the Medicaid expansion,” Senate President Keith Faber told the Columbus Dispatch in January. “But it expanded, and now we have to make it work.”

McClinon didn’t get on Medicaid immediately. He tried free clinics in Chicago while applying for Medicaid, which was eventually denied. He dropped out of school and returned to Cincinnati where he struggled with daily activities and employment. Normally a high-functioning epileptic, McClinon says his seizures started to affect him more frequently, mostly his memory.

McClinon has the type of seizures that involves spacing out for long periods, he says, almost like he was daydreaming, but he would come back with no memory of the incident. His medication to control his seizures was making it harder and harder for his short-term memory to function correctly.

“It was almost like I was a little kid,” McClinon says.

McClinon tried again to enroll in Medicaid but had difficulty doing the paperwork and waiting long periods for a response. Meanwhile, he relied on free clinics and continued to have several seizures a month. He eventually ended up homeless for nine months.

In January of 2014, when Ohio’s Medicaid expansion went into effect, McClinon, with help from a friend, enrolled the first day he could. By February, he was covered, and he finally had his operation in July 2014.

“I’m very thankful that the act came into play, because I could not afford all the care I got,” he says. “I think that my surgery alone was like $100,000. I would not have been able to afford that.”

McClinton is one of the 537,010 Ohioans who have enrolled in the Medicaid expansion as of May 2015, according to Ohio’s Department of Medicaid, a total exceeding the state’s initial predictions by more than 170,000.

During the 18 months since Ohio rolled out the program, 95 percent of those who were newly eligible have enrolled in the expansion. The addition has brought the total number of Ohioans on Medicaid to 2.9 million.

For Medicaid advocates like Trey Daly, Ohio state director of Get Covered America, this expansion means this portion of the population is finally getting the kind of health coverage it needs.

“They’re using their services. They’re using the right kind of services — preventive health care, not emergency room and in-patient care,” Daly says. “So it’s a good news story for the most part.”

But for Republicans, the issue about how to cover the state’s share of the cost — 10 percent — which is slated to kick in after the initial two years of the program. The federal government is paying for the expansion up until the end of this year; after that, the state of Ohio will need to kick in. In its most recent two-year state budget, Ohio is slated to spend $11.9 million of its general revenue fund to keep the expansion running.

Medicaid expansion was set up under the Affordable Healthcare Act for those who fall into the “Medicaid gap,” meaning their income was sitting a level where they didn’t qualify for Medicaid or marketplace subsidies. Marketplace subsidies are open to anyone between 100 and 400 percent of the poverty line. In some states, Medicaid was only available to those under the federal poverty line — sometimes as low as 50 percent below the federal poverty line. The Medicaid expansion extended that line so everyone who made up to 138 percent of the federal poverty line was covered. In 2012, the Supreme Court ruled that individual states could choose whether or not to accept the expansion.   

Republicans in Ohio fought against the expansion, but in a controversial move, Gov. John Kasich bypassed the legislature and pushed through the extension through the legislature’s seven-member Controlling Board, a committee typically tasked to much smaller budget adjustments. In a vote of 5-2, it approved accepting $2.5 billion from the federal government for a two-year Medicaid extension to individuals who made less than $16,105 a year or were below 138 percent of the federal poverty line.       

Kasich, currently running for the GOP presidential nomination, has defended the move he made against his own party in 2013 to adopt the extension.       

“If other people don’t want to take the money, that’s up to them, but I got money I can bring home to Ohio,” Kasich told NPR last May. “It’s my money. There’s no money in Washington. It’s my money. It’s the money of the people who live in my state.”

As part of the state budget Kasich signed last June, he and other GOP legislators included a plan that would require non-disabled Medicaid recipients to contribute either $99 or 2 percent of their income per family member, whichever is lower, into a health savings account. Medicaid would contribute $1,000. The money would go toward paying the individual’s medical expenses, like private insurance. This plan replaces Kasich’s original proposal that required Medicaid recipients above the poverty line to pay a premium of $20 a month.

The idea is that Medicaid recipients will be more responsible when seeking out care and will be able to better transition to private insurance when, or if, that times comes.

Daly and other Medicaid advocates argue that it will create another burden for low-income people.

“We know that Medicaid has always allowed states to charge co-payments or premiums, so it’s not necessarily something new,” Daly says. “In the past, when other states have done that, there has been either a reduction in utilization or reduction in enrollment.”

That plan is still waiting on permission from the federal government, which has yet to approve any plan that would drop those living under the poverty line for not paying into a health savings account. But it’s more ambiguous for those above that line.

“The purpose of the program is to provide access to care,” Daly says. “And if you’re creating a barrier, then the program is not working the way it’s supposed to work.” ©     

UPDATE: An earlier version of this story referred to Get Covered America as Get Enrolled America.

Enroll America is a national healthcare enrollment coalition that runs the Get Covered America campaign, which is focused on outreach and education on the Affordable Care Act.

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