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Medicaid

Providing Health Care Coverage for 3 Million Ohioans

Medicaid and the Children’s Health Insurance Program provide health care coverage for people with disabilities and for low-income Ohioans — families and children, pregnant women and the elderly. Today, one in four Ohioans is enrolled in Medicaid, with 83,000 active providers caring for 3 million individuals.
 
The Medicaid program is jointly funded by states and the federal government. In Ohio, the current Federal Medical Assistance Percentage, or FMAP, for most Medicaid expenditures is 63.02 percent; 85.6 percent for children; and 93 percent for Medicaid expansion.

FINANCE NEWS - MEDICAID

Connect here to view Medicaid-specific Finance News prepared by OHA's Health Economics & Policy team.

MEDICAID AND OHIO HOSPITALS

Medicaid was the payer in 22 percent of Ohio hospital encounters in 2017 reimbursing hospitals 79 cents on the dollar for the cost of caring for Medicaid beneficiaries. Ohio hospitals serving a disproportionate share of poor and disabled Ohioans received $388 million in supplement payments in 2016 though hospitals statewide posted a $2.3 billion loss on Medicaid reimbursements.

MEDICAID EXPANSION

Ohio expanded Medicaid program eligibility in 2014 to include additional uninsured adults with incomes up to 138 percent of the federal poverty level. In state fiscal year 2017 the expansion group accounted for 23.1 percent of Ohio’s Medicaid enrollment and 22.9 percent of Ohio’s Medicaid expenditures.
 
To be eligible for Medicaid coverage, individuals must:

  • Be a United States citizen or meet Medicaid citizenship requirements
  • Have or get a Social Security number
  • Be an Ohio resident
  • Meet financial requirements according to Modified Adjusted Gross Income

WHO IS COVERED

The Ohio Department of Medicaid reports beneficiaries and expenses by four eligibility categories. Each group has its own income requirements:

  • Covered Families and Children, or CFC—Pregnant women, infants and children
  • Group VIII, expansion population—Individuals at or below 138 percent of the federal poverty level, including childless adults
  • Aged, Blind and Disabled, or ABD—Individuals with disabilities
  • Other—Including elderly

WHAT MEDICAID COVERS

Medicaid assists in paying for:

  • Inpatient and outpatient hospital care
  • Physician, midwife and specific nurse practitioner care
  • Laboratory and x-ray services
  • Nursing home and home health care
  • Early and periodic screening, diagnosis and treatment for children under age 19
  • Family planning
  • Rural health clinics/federal qualified health centers
  • Prescription drugs

PAYMENT REFORM

OHA's Health Economics & Policy team has helped members navigate the Ohio Department of Medicaid's State Innovation Model, or SIM, test of multi-payer, value-based payment models. OHA analysts and member hospitals are providing feedback to the state as it works to transition to value-based alternatives to fee-for-service payments for care.  

The state has received a federal grant for SIM testing. Ohio's SIM focues on increasing access to patient-centered medical homes and implementing episode-based payments. Read more about the program here.