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Ohio House Budget: A Mixed Bag for Health Reform

Ohio’s biennial budget process is not for the faint of heart. Looking through the lens of health reform, the Governor’s budget had its highs and lows; the emerging House version went both higher and lower.

The Governor’s budget (House Bill 64), introduced in February, included funding for the entire Medicaid program, including Ohioans who became newly eligible on January 1, 2014, when the ACA’s Medicaid Expansion took effect.

That same proposal, however, eliminated Medicaid eligibility for pregnant women, family planning services, and the Breast and Cervical Cancer program with incomes 139-200% FPL. The administration also announced its intention to seek a federal waiver to charge premiums to non-pregnant adults on Medicaid with incomes over 100% FPL.   

And a proposal to eliminate Independent Providers of home care services from Medicaid caused a huge uproar, especially from people with disabilities and their advocates.

On April 14, 2015, the House released its Substitute HB 64, filled with goodies and electrical shocks.

Good news: Independent Provider language was pulled from the budget, pending new language creating a process to make consumer self-direction (with independent providers) available to all home care users.

Biggest disappointment: Despite considerable advocacy in support of the programs, the House failed to restore eligibility for pregnant women, family planning services, and breast and cervical cancer treatment up to 200% FPL.

Biggest Shocker:  The “Healthy Ohio” plan would require Ohio to seek a waiver to enroll most people on Medicaid, including children, in managed care with a “Buckeye” account, a kind of Health Savings Account.  Everyone – even people with zero income – will be required to pay premiums, and failure to do so will result in being locked out of Medicaid for one year. The complexity will generate significant administration expenses and cause many recipients to lose coverage (for more on the proposed waiver, see Ohio Consumers for Health Coverage testimony).  Ohio’s plan is based on the waiver Indiana negotiated with the federal government as inducement to expand Medicaid. Not only is Ohio’s plan even more harsh, but Ohio already enacted the Medicaid expansion – so why should CMS negotiate a waiver like this?

Scary stuff: The bill shifts authority for determining Medicaid coverage of optional eligibility groups from the Office of Health Transformation to the legislature (RC 5163.03) and limits the amount of money for which the Controlling Board can authorize spending (remember, they authorized federal funds to pay for Medicaid expansion). 

Blank Check to Big PhRMA Award: The bill prohibits prior authorization of prescription drugs in Medicaid (RC5166.52). The ability of Medicaid to require prior authorization of certain prescription drugs for which there are cheaper, but equally effective, alternatives eliminates a tool for Medicaid to control costs.

Efforts to Reduce Unnecessary Spending and Improve Quality: Several provisions showed up that have the potential to move us toward better care at lower costs. These include a requirement for the Office of Health Transformation to develop a Hospital Report Card and the creation of an All-Payer Claims Database, which allows you to track health care spending across insurers, employers, government, and individuals, which can be an important tool to monitor patient safety, effectiveness of care, and health equity – if consumers have strong input. Also in there is a requirement for providers to give patients information on cost of treatment beforehand. This is a great idea, but will be hard to enact without other changes.

We’ll be writing about other provisions later on. Stay tuned.

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