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% 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% of the federal poverty level. In state fiscal year 2018 the expansion group accounted for 24% of Ohio’s Medicaid enrollment. 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 focuses on increasing access to patient-centered medical homes and implementing episode-based payments. Read more about the program here.
QUICK LINKS Ohio Department of Medicaid Ohio Medicaid Quality and Utilization Program See Bluemark financial management and audit tools available to OHA members