Many supporters of Ohio’s Medicaid expansion are confident that the Obama administration’s Center for Medicaid and Medicare Services (CMS) will reject Ohio’s application to implement “Healthy Ohio” for most Ohio adults on Medicaid. (For more on “Healthy Ohio,” click here.)

After all, unlike most other states requesting waivers, Ohio has been implementing the Medicaid expansion since January 2014 and it’s been an overwhelming success, with over 600,000 now receiving regular health care. And the Kasich administration tried to steer legislators away from putting such a complex proposal in statute, wishing instead to have flexibility to negotiate something less onerous than “Healthy Ohio.”

However, recent decisions from CMS granting Medicaid waivers with major beneficiary restrictions should give pause to supporters of Ohio’s Medicaid expansion who believe that Ohio’s application will be dead on arrival. On November 2, CMS approved Montana’s Medicaid waiver, which expands Medicaid eligibility but requires recipients to pay premiums amounting to two percent of their income. Worse, these premiums are applicable to people with incomes at or above 50% of the federal poverty level (that’s $5885 a year for one person).  Individuals between 100-138% FPL could lose coverage if they are more than 90 days late on premiums and they would be locked out for one quarter if they fail to pay back owed premiums. These and other provisions will cause people to lose their coverage and not return until they get sick. Cost sharing will keep people from seeking needed preventative care in a timely basis.

The approval by CMS of a waiver very similar to Ohio’s is a warning to opponents of Healthy Ohio that we can’t be too confident that CMS will reject “Healthy Ohio” application – at least not without hearing from a wide range of stakeholders why this waiver is not in Ohio’s best interests. However, there is a key difference between the situations in Ohio and Montana: Ohio has already successfully expanded Medicaid, whereas the approval of Montana’s waiver will put expanded Medicaid into effect on January 1, 2016. Since Ohio’s expansion of Medicaid does not rely on the waiver’s approval, advocates can argue that Ohio already has a working system in place and does not need the additional changes in the waiver.

On the other hand, Arizona has requested a waiver with provisions similar to those found in other states – premiums for people with low incomes, cost sharing, and provisions requiring enrollees to take certain actions to demonstrate “personal responsibility.”  Like Ohio, Arizona already implemented the Medicaid expansion and politicians are seeking to impose more “personal responsibility” – that is, hurdles – in the paths of low-income people on Medicaid. Public comments on the Arizona waiver are due on December 6. UHCAN Ohio will be submitting comments; others are encouraged to do so as well.

In Ohio, the administration plans to submit its application by spring of 2016. Before filing with CMS, they are required to seek public comments. Then, after submitting the application, CMS opens up a public comment period. Supporters of Medicaid expansion across the spectrum – providers, consumers, and other stakeholders – need to be ready to join UHCAN Ohio in sending a strong message to CMS that Healthy Ohio is bad for Ohioans.

On the Brighter Side…

In this blog, Community Catalyst offers evidence that “reason is slowly gaining ground over ideology in the debate over Medicaid expansions.”