As pandemic ebbs, fears grow that Ohioans will be improperly forced off of Medicaid

Brooke Phillips, CWCMS
Editor | Shield HealthCare
04/25/22  11:00 AM PST
Ohioans forced off Medicaid

State to decertify recipients much faster than federal guidelines require

Ohioans are no doubt greatly relieved that the coronavirus pandemic appears to be winding down — and taking with it the sickness, death and inconvenience of the past two years.

But as it does, thousands of Ohioans will be hustled off of Medicaid, the health program for the poor and disabled. And it’s unclear what remedies they’ll have if they’re taken off the program improperly.

In March 2020, as the pandemic gripped the country and no vaccines were available, Congress passed the Families First Coronavirus Response Act. Among its other provisions, it prohibited states from taking people off their Medicaid rolls unless they moved out of state or asked to be removed.

As a consequence, Ohio’s Medicaid roles grew by 20.5% between March 2020 and March 2022, according to the Health Policy Institute of Ohio. With 3.37 million enrollees, the Ohio Department of Medicaid is now covering 29% of the state’s population.

Some Ohioans are still dealing with health and childcare issues that kept them from working during the epidemic. But some undoubtedly have returned to work and are earning too much to be eligible for Medicaid, absent the health emergency.

The federal government earlier this month extended the emergency until July, but there’s widespread worry about what will happen after that.

The U.S. Department of Health and Human Services is giving states 12 months after expiration to complete the “redetermination” process to see which Medicaid recipients are no longer eligible — and it’s urging them to do it carefully. But under the budget passed last year by the GOP-controlled Ohio legislature, the process must be completed within 90 days of the end of the health emergency.

“Hundreds of thousands of Ohioans are at risk of falling off,” Daniel van Hoogstraten, a spokesman for the progressive group Protect Our Care Ohio said in a press conference earlier this month. “The state needs to do all it can… to ensure that they’re not trying to save a buck by trying to get people off the system as quickly as possible.”

Federal coronavirus measures might have created an incentive for states to push people off their Medicaid roles quickly. At the start of the pandemic, the feds increased their share of Medicaid support by 6.2 percentage points — or $300 million per quarter in Ohio — but that funding will expire at the end of the quarter in which the health emergency expires, the Health Policy Institute reported.

So, in the event of a July expiration of the health emergency and the loss of so much federal funding looming in September, there will be a lot of pressure on the Medicaid department to trim its rolls — and fast.

Perhaps disconcertingly, the Ohio Department of Medicaid has hired a consultant for the job that says it can use third-party information to complete the job in days, NBC News reported in December. The state budget appropriated $35 million for the job and the Medicaid department will pay Boston-based Public Consulting Group 10%-20% of the money that is saved by declaring Medicaid recipients ineligible, the news organization reported.

So is that an incentive for the consultant to push as many Ohioans as possible off of the Medicaid roles without checking too carefully whether they’re really ineligible? Numerous experts have pointed out that people whose lives have been upended by the pandemic — and by poverty and housing insecurity more generally — find it harder to maintain contact with health authorities and clear the bureaucratic hurdles to stay on Medicaid.

The Ohio Department of Medicaid didn’t respond last week when asked what it was doing to make sure county-level officials are working with Medicaid enrollees to ensure those still eligible retain their benefits. It also didn’t respond to a question asking whether Public Consulting Group would face any penalties for incorrectly declaring Medicaid clients ineligible.

Public Consulting Group also didn’t respond to a request for comment.

Ohio Rep. Thomas West of Canton is ranking Democratic member of the state’s Joint Medicaid Oversight Committee. In this month’s press conference, he said the committee is looking into how the enrollment-evaluation process will be handled.

“We’re waiting for answers around the redetermination process and what Medicaid is going to do along these lines to ensure that Ohioans will be protected,” he said.

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