Four years after the Republican-run spending oversight panel voted to approve Medicaid expansion in Ohio, the state Controlling Board will decide Monday whether the health insurance program will remain fully funded.
Gov. John Kasich’s Medicaid Department will ask the board to release $264 million in state funding that would be used to collect $638 million in federal matching money.
The stakes are enormous. Rejection of the request could bring a funding cutoff next spring for more than a quarter of Ohioans who depend on Medicaid for health care. Few believe such a worst-case scenario will actually occur, but it underscores the important role of a state board seldom in the limelight.
The request itself is unusual. Normally, lawmakers budget an amount for Medicaid spending in the two-year budget, and the administration is expected to spend no more than that. In recent years, Medicaid spending has finished far below what was initially allocated.
But with lingering unhappiness over the Medicaid expansion vote, growing skepticism over the Kasich administration’s Medicaid cost projections, and a desire to be more involved in the largest portion of the state budget, Monday’s Controlling Board meeting was born.
Lawmakers wanted to question the administration in an open hearing before deciding whether to approve a specific portion of Medicaid funding. Medicaid Director Barbara Sears and state Budget Director Tim Keen will take questions Monday.
Majority lawmakers made a similar attempt two years ago, but Medicaid underspending allowed Kasich to fully fund services without needing to ask permission to spend the money that was set aside. That move angered some members, including Sen. Bill Coley, R-West Chester, a member of the Controlling Board who ripped into Keen during a routine budget hearing in April.
This time, Kasich can’t avoid asking board permission.
“We asked for the responsibility. We’re going to make sure we’re paying attention to what we’re doing,” said Speaker Cliff Rosenberger, R-Clarksville, declining to speculate if the request would be approved. “We’re going to make sure we work with the administration to ensure we’re taking care of the drug addicted and the mentally ill.”
Without Controlling Board approval, the Kasich administration says it has two options: cutting Medicaid payments by 16 percent starting Jan. 1 to doctors, hospitals, home health-care workers and others, excluding nursing homes, which GOP lawmakers protected from rate cuts; or end Medicaid funding in Ohio, which pays for the medical care of around 3 million Ohioans. In that event, administration officials have said they prefer the latter option, so all recipients share in the pain.
“What I’m looking at is, what is the cost of doing this versus the cost of not doing this?” said Rep. Al Landis, R-Dover, a Controlling Board member. “I don’t think there is a perfect solution, but we’re going to try to come up with the best we can.”
Landis said he can’t disagree with the Kasich administration’s Medicaid numbers, but he’s interested to learn more Monday.
“My decision is still up in the air until I hear the final explanations,” he said.
Few moments have caused such lingering anger and political consternation inside the Statehouse as the events of Oct. 21, 2013, when the Controlling Board voted 5-2 to approve Medicaid expansion, eventually providing coverage to more than 700,000 adult Ohioans making less than 138 percent of the federal poverty level.
The vote was bipartisan — Republican Sen. Chris Widener of Springfield, at the time the No. 2 Senate leader under then-President Keith Faber, and Rep. Ross McGregor, also of Springfield, known as one of the few true moderates in his GOP caucus, joined the two Democratic members and a Kasich appointee in approving the measure.
Since then, various Republicans have tried to upend the move, complaining that Kasich used the Controlling Board as an end run around a legislature that was unlikely to approve the expansion.
As part of the current budget bill passed in June, lawmakers tried to freeze Medicaid expansion enrollment starting in July 2018. Kasich vetoed the provision, and so far, lawmakers have not attempted an override.
Faber was not a fan of expansion, but he declined to remove Widener from the board in 2013. “I generally trust my members … to do what is in Ohio’s interest and what’s in the interest of their districts,” Faber said at the time.
Then-Speaker William G. Batchelder, R-Napoleon, went a step further, swapping Rosenberger, a “no” vote, off the board for McGregor, a known expansion supporter.
Asked later about it, Batchelder suggested his caucus, as a whole, privately supported Medicaid expansion.
“Over the years, you learn how to talk to people and find out what they’re thinking. Not what they’re saying — what they’re thinking,” he said.
Approval of the funding on Monday would take support from only one of the four Republicans on the Controlling Board, if the two Democratic members and Kasich’s appointed president, Christine Morrison, vote for it.
The Kasich administration also must come back to Controlling Board next year to ask for the release of another $311 million in Medicaid funding that would draw down $750 million in federal money.