What’s Ahead for Health Coverage in 2008?

An Update and Status Report

As you may remember, Ohio’s FY 2008-2009 budget, passed nearly unanimously by the legislature and signed by Governor Strickland on June 30, 2007, includes several provisions that will extend access to health care to more children, including:

• Raise the Medicaid eligibility for pregnant women from 150% of the federal poverty level (FPL) to 200% FPL.
• Allow Ohio children emancipating from the foster care system to keep Medicaid coverage until age 21.
• Create a new program—the Children’s Buy-In program (CBI)-- to allow certain uninsured children living in families with incomes over 300% FPL to buy public health coverage on a sliding fee scale.
• Raise the Medicaid/SCHIP eligibility for Ohio children from 200% FPL to 300% FPL.

If you are interested, you can view a more detailed description of each initiative.

Since June 30, advocacy work through Voices for Ohio’s Children, the Ohio Covering Kids and Families Coalition, and other partners, has focused on influencing program design and implementation plans to help make sure these expansions are a success. We have had numerous meetings with Medicaid eligibility, policy, managed care, and communications staff, have commented on proposed rules, made presentations to community groups, provided training at eight briefings around the state in partnership with UHCAN Ohio, convened key stakeholders to provide input and training, and briefed legislators, legislative staff , and members of the media. This work will continue throughout 2008 as the expansions are implemented.

The chart below provides an update on each initiative. This information was provided by the Office of Ohio Health Plans (Ohio Medicaid program) in December 2007.

A special note on the medicaid/schip expansion for children from 200-300% FPL. This initiative has received a lot of attention because it is related to the debate in Washington DC on federal SCHIP reauthorization. On December 20, 2007, the Centers for Medicare and Medicaid Services (CMS) denied Ohio’s State Plan Amendment to expand Medicaid for children from 200 to 300% FPL. (For more information, read Voices’ press release on this decision.) While disappointing, this decision was not unexpected as CMS had already denied several other states’ applications to cover kids beyond 200% FPL. Governor Strickland has vowed to pursue the full expansion and is considering what options Ohio has to expand coverage for children to 300% FPL. Because CMS has approved at least one other state to expand coverage to 250% FPL, we speculate it is likely that Ohio will file an application to do the same. This would create a coverage gap for kids between 251-300% FPL, until Ohio can secure federal permission or an alternate mechanism to cover these kids. This expansion is still very much “in play” – we will keep you posted as we hear more. For now, Medicaid/SCHIP eligibility for children remains at 200% FPL.

Summary of Ohio Health Care Expansions as Authorized in HB 119
Estimated # of Enrollees By Population Category Compared with Estimated # of Uninsured

In SFY 2007, Ohio’s SCHIP/Medicaid enrollment for children in families with incomes < 200% of the Federal Poverty Level (FPL) was:

• SCHIP = 150,000;
• Medicaid = 850,000;
• Estimated # children eligible for SCHIP or Medicaid but not enrolled = 118,000