Medicaid is a state and federally funded program that guarantees health care coverage to eligible low-income and medically vulnerable people including: Children (up to 19), pregnant women, parents of children under 18, non-workers with disabilities, and Ohioans aged 65 or older. With the enactment of Medicaid expansion in 2014, childless adults with incomes under 138% of the federal poverty level can also receive Medicaid coverage.
In 2013, Ohio launched the Ohio Department of Medicaid, the state's first Executive-level Medicaid agency. With a network of more than 70,000 active providers, Ohio's Medicaid and its managed care plans deliver health care coverage to over 2.8 million residents of Ohio on a daily basis. Working closely with stakeholders, advocates, medical professionals, and fellow state agencies, the agency continues to find new ways to modernize Medicaid in Ohio.
Medicaid covers 1-in-6 Ohioans, 1-in-3 Ohio children and 1-in-10 Ohio seniors aged 65+.Medicaid services include:
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
Rural health clinics/federal qualified health centers
In Ohio, most individuals who have Medicaid must join a managed care plan to receive their health care. Managed care plans are health insurance companies that are licensed by the Ohio Department of Insurance and have a provider agreement with the Ohio Department of Medicaid to provide coordinated health care to Medicaid beneficiaries. These managed care plans work with hospitals, doctors and other health care providers to coordinate care and to provide the health care services that are available with an Ohio Medicaid card. For more information on ODM - click here.
Medicaid & Hospitals
Ohio Medicaid reimburses Ohio hospitals 83 cents for each dollar it costs to treat Medicaid beneficiaries. Medicaid losses to Ohio hospitals continues to grow as over 2.8 million Ohioans are now beneficiaries of this program. Ohio hospitals experience in a $1.35 billion Medicaid loss based on 2013 data. For eligibility rules on Medicaid reimbursement, see OAC 5160-2-01.
Medicaid & Health Care Reform
In 2014, Ohio expanded the Medicaid program to include new uninsured adults with incomes up to 138 percent of the federal poverty level - estimated 275,000 eligible Ohioans.The federal government pays 100 percent of the cost for expanding Medicaid eligibility through 2016, with a gradual reduction to paying 90 percent of the cost in 2017 and beyond. Ohio's Controlling Board voted 5-2 to authorize the spending of federal-only funds to extend Medicaid coverage in Ohio beginning January 1, 2014. The Ohio Department of Medicaid requested the Controlling Board to increase appropriation authority by $562 million in state fiscal year 2014 and $2 billion in state fiscal year 2015. This increase in appropriations. The federal government approved this process allowing for Ohio to expand coverage.
Affordable Care Act
Beginning in 2015, Medicaid payments to Ohio hospitals will be reduced by a total of $521.2 million over five years. According to the American Hospital Association, hospital Medicare and Medicaid payments were cut by $113 billion since 2010 as a result of the ACA and regulatory actions.
OHA supported an Ohio Office of Medical Assistance (OMA) conversion to a Medicaid All Patient Refined, Diagnosis-Related Group prospective payment system (APR-DRG PPS), effective July 1, 2013. The APR-DRG replaced an unsophisticated, 15-year-old, Medicare-based PPS that did not allow OMA to severity-adjust Medicaid discharges for more accurate analysis and payment. Ohio law requires Medicaid payments under the new PPS to be at least budget-neutral compared to payments under the old system, but OHA successfully negotiated with OMA to add an estimated $84 million in annual inpatient Medicaid reimbursement to Ohio hospitals.
These negotiations include a $24 million annual increase to rural and critical access hospitals and the inclusion of a stop loss/stop gain risk corridor for urban hospitals to ensure payment stability over a three-year conversion. Still to be addressed later this summer are issues related to reimbursement for hospitals with medical education programs and how OMA will “peer-group” hospitals for future PPS refinements.