Ohio Medicaid Expansion Runs 33 Percent over Budget in First Year

Published February 17, 2015

Enrollment in Ohio’s expanded Medicaid program was 485,462 in December 2014, 33 percent higher than expected.

Gov. John Kasich’s (R) Medicaid expansion took effect in January 2014, and it has been over budget ever since. Enrollment was at 492,121 in January, 34 percent higher than the initial projection for July 2015.

The Ohio Department of Medicaid (ODM) did not release a December caseload study, but a December eligibility and expenditures report pegged enrollment at 471,452. Caseload reports, which include revisions for previous months, have consistently shown large increases in previous months’ enrollment due to backdated eligibility.

For example, June enrollment in Kasich’s Medicaid expansion was initially reported as 285,553 before increasing in every subsequent caseload report. June enrollment was revised to 367,446 in ODM’s January 2015 caseload release.

“Though it won’t save Ohio taxpayers from paying the growing check he has written, it would be nice if John Kasich admitted he was wrong on enrollment numbers and showed an ounce of remorse for being so wrong,” said Matt Mayer, president of the free-market think tank Opportunity Ohio.

“The same goes for the editorial boards who continue to shill for Medicaid expansion in spite of the cold, hard facts of what it is going to cost us,” Mayer added.

$300 Million More Per Month

July 2014 enrollment, first reported as 338,707, has been revised upward every month and was reported as 394,162 in the January 2015 caseload release. November 2014 enrollment jumped from 450,941 in the November report to 469,737 in January 2015.

Ohio used more than $2.1 billion in federal funding to pay for Medicaid expansion benefits through December. A $2.56 billion Ohio Controlling Board appropriation for the expansion was planned to last until July 2015.

With monthly expenditures topping $300 million by the end of 2014, ODM likely exhausted its Controlling Board appropriation in February 2015. The Kasich administration has not responded to inquiries about how it plans to pay for Medicaid expansion through June 2015.

Republican leaders in the Ohio House and Senate have signaled they would make no effort to overturn Kasich’s unilateral expansion of Medicaid to able-bodied, working-age adults with no dependent children.

Governor Suggests Medicaid Premiums

After putting an additional half a million Ohioans on Medicaid, Kasich is emphasizing “welfare to work” proposals in his budget for fiscal years 2016 and 2017.

In a House Finance and Appropriations Committee hearing in February, Democrats expressed skepticism toward Kasich’s recommendation adults on Medicaid pay small premiums if their income exceeds 100 percent of the federal poverty line.

“My concern is it will turn less into a personal responsibility issue [and] more into an unnecessary burden, an unnecessary obligation,” state Rep. Dan Ramos (D-Lorain) said.

Ramos asked, “Where’s the idea that this is a responsibility issue for these folks who have responsibilities, who have bills, who have a job?”

The Kasich administration has estimated “about half” the Ohioans added to Medicaid under Obamacare have jobs.

Obamacare Complications

Greg Moody, director of Kasich’s Office of Health Transformation, says eligibility for Obamacare exchange subsidies begins at 100 percent of the federal poverty line.

“Without expansion, federal law requires individuals to have insurance for which they pay a premium on a monthly basis that, at low-income ranges around 100 percent [of the federal poverty level], are about $20 a month,” Moody said.

“It seems fair to reflect that policy so as to not create a distinction between people at exactly the same income level when they make a choice to get coverage through the exchange versus coverage through Medicaid,” said Moody.

Kasich, who says his Medicaid expansion has nothing to do with Obamacare, could address this issue by capping Medicaid eligibility at 100 percent of poverty, but that would mean missing out on billions in new federal funding.

Kasich has vigorously defended his decision to add almost 500,000 people to a federally funded entitlement program and has challenged Republicans who have refused to take federal dollars offered by the Affordable Care Act.

Jason Hart ([email protected]) writes for Watchdog.org, where an earlier version of this story previously appeared. Reprinted with permission.