There are 769,869 Ohioans receiving Medicaid through expansion of the program under the Affordable Care Act - which could end under a provision in Gov. Mike DeWine's budget.
The federal government pays 65% of traditional Medicaid costs. The federal medical assistance percentage (FMAP) is 90% of Medicaid expansion costs for the population known as Group VIII. Gov. Mike DeWine’s budget states that Medicaid expansion coverage would end if the percentage drops below 90%.
The budget analysis from the Legislative Service Commission, which reviews legislation for lawmakers, said: "The bill specifies that if the FMAP for medical assistance provided to Group VIII enrollees is set below 90%, ODM must immediately terminate medical assistance for members of the group."
It's a money issue, said Ohio Medicaid Director Maureen Corcoran.
"If they drop it by 5%, if they go from just 90% to 85%, that would cost the state about $380 million," Corcoran said. "And if they went all the way down to 65%—our regular amount—then they'd be dropping it by five times that. So we're up near $2 billion."
The proposed federal budget from majority Republicans in the US House would cut $880 billion from Medicaid over the next decade, and scaling back that match is among the possibilities.
Corcoran said talks continue with Ohio lawmakers on that trigger language.
"The discussion that we've been having with the legislature is really around, we need a clear trigger so that if this happens there can be additional conversation with the General Assembly. They they would have to act. They control the purse," Corcoran said.
And she added that even if the budget passes with the trigger language intact and if the federal government cuts the percentage, it won't be the immediate impact that advocates for Medicaid expansion fear.
"Nothing like this occurs overnight, so it's not that you're going to show up at the hospital the next day and not have coverage," Corcoran said. "It all takes guidance from the federal government to tell you, you know, what you have to do. And all that. So we don't know how much time, but there would be, you know, some back and forth in some time that would be needed before any kind of terminations of individuals would occur."
At least nine other states also have similar trigger language that might cut that coverage.
This comes as Ohio is also requesting permission from the Trump administration to impose work requirements on the Medicaid expansion population. Recipients would have to work 80 hours a month unless they're over 55, already enrolled in school or training or in a recovery program, or have a serious serious physical or mental illness. If the request is granted, Corcoran said it's assumed around 62,000 people receiving Medicaid through expansion would not meet those exceptions and would either need to add work hours or lose their coverage.
