With the end of pandemic-era policies and benefits, Ohio officials estimate that as many as 280,000 of Ohio’s 3.55 million enrolled residents could lose Medicaid.
About 1 million Americans have already lost coverage from the government-paid health insurance program for children, low-income adults, seniors, and people with disabilities since federally mandated automatic re-enrollment into the program ended March 31, including 24,000 Ohioans who have lost the benefit since late May, according to the Ohio Department of Medicaid.
Now, people have to manually re-enroll to get coverage.
Meanwhile, Ohio is one of the states that spends the most on insuring its citizens, but falls short in terms of access and quality of health care.
How Ohio’s Medicaid spending compares to other states
Ohio has spent $27.6 billion on Medicaid, ranking sixth in the nation in spending, according to the most recent numbers, since 2021, from the Kaiser Family Foundation, a nonpartisan health policy organization.
Before Ohio in spending is California, in first place with more than $100 billion; then New York; Texas; Pennsylvania; and Florida. Every state is ahead of Ohio when it comes to total population. Ohio’s population is the seventh highest in the nation.
Total Medicaid spending in the nation was $748 billion in 2021, according to the foundation.
But when it comes to overall population health, Ohio isn’t ranked highly—it’s nearly in the bottom 44 out of 50, according to the Health Policy Institute of Ohio. This is measured by a number of factors, including population physical activity, alcohol consumption, suicide, depression, infant mortality, life expectancy, chronic disease and more. By comparison, California is ranked third out of 50.
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We have less healthy lives here in Ohio and spend more on health care than people in many other states, said Edith Nkenganyi, a policy analyst at the Health Policy Institute of Ohio, who worked on its 2023 Health Value Dashboard to Ohio.
That’s not good, said Amy Rohling McGee, president of the Health Policy Institute of Ohio. We have plenty of room for improvement.”
What is Medicaid and how many Ohioans have it?
Medicaid is a public health insurance program for those who can’t afford their own and, in Ohio, is the state’s largest single insurer, according to Policy Matters Ohio, a nonprofit research institute.
To qualify for Medicaid in Ohio, a single-person household would need to have an annual pre-tax income of less than $19,392.
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The program, which is a partnership between the state and federal governments, covers different things in different states, although all states are required to pay for certain federally mandated services for their residents.
Thirty percent of Ohioans, or about 3.55 million people, have Medicaid, making it an essential way people can access care, according to Rohling McGee and the institution’s Ohio Medicaid Basics Report 2023, released in May.
Most of these people, more than 1.33 million, are children.
Medicaid also accounts for a large percentage of state money, with about 39 percent of the state’s $110 billion budget going to the program in 2022, according to the institute.
Why is the state spending so much money on Medicaid?
During the COVID-19 pandemic, from February 2020 to December 2022, Ohioans receiving federal benefits grew by 29.6%, from 2.5 million to 3.3 million, according to the Kaiser Family Foundation.
This is in part because, when the COVID-19 public health emergency began, the federal government began automatically enrolling people in Medicaid, and many also remained unemployed during the pandemic. Ohio’s enrollment growth during the pandemic was the sixth-largest, at 837,600 enrolled.
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In addition to having one of the state’s largest populations to insure, Ohio also pays for some coverage beyond the minimum federal Medicaid regulations. These optional services include pharmaceutical benefits, physical therapy, ambulance transportation, chiropractic care, alcohol and drug screening, podiatry, speech therapy, telehealth and dental care, which each state can determine whether it will offer, Rohling McGee said.
Ohio also recently extended postpartum coverage for mothers from 60 days after birth to one year, by which time newborns are already covered.
The amount Ohio spends on Medicaid coverage has increased over time, Rohling McGee said, in part because, although the state can allocate a certain amount, more people could end up eligible than planned. which increases the actual amount spent.
In addition, Ohio’s health care spending is mostly spent on expensive individual care to treat health problems, Amy Bush Stevens, vice chair of research and evaluation at the Health Policy Institute of Ohio, said in a statement. Some of these problems could be caused by the fact that there are many tobacco users in the state and smoking causes disease and disability, according to the Centers for Disease Control and Prevention.
“Our health is shaped by many factors beyond clinical care, such as education, employment, access to healthy food and air quality,” he said. “Ohio performs worse than most other states on metrics related to social, economic, and physical environments.”
Nearly 20 percent of Ohio adults smoke tobacco, according to the Ohio Department of Health.
“Tobacco use is one of the key contributing factors to Ohio’s poor performance on the Health Value Dashboard,” according to the institute. “Ohio’s consistently low rank in the adult smoking metric (44th in this edition) helps explain why the state struggles to improve health and control spending compared to other states.”
Ohio also has poor outdoor air quality, many toxic pollutants and a high overdose rate, all of which contribute to its poor health rating, according to the institute.
The state needs to focus more on prevention and health drivers to strengthen Ohio’s performance and help more Ohioans live healthily, Bush Stevens said.
Access to health care in Ohio
Ohio’s access to health care isn’t as high as its spending, according to the Health Policy Institute of Ohio.
The organization ranked the state’s access to care 20 out of 50 states for 2022, due to a lack of mental health and medical professionals to serve underserved communities and fewer children receiving preventive dental care than to previous years.
For 2021, the institution ranked Ohio seventh out of 50 states for the same metric, but a lot has gotten worse since then when it comes to health care access in the state. Access was determined by looking at how easy it is for Ohioans to obtain needs such as health care coverage, affordable care, the ability to see a primary care provider, and find access to mental health care.
The institute’s dashboard also provides recommendations for Ohio to improve the health of its residents, Rohling McGee said. These include increasing people’s ability to work with more vocational technical education and childcare; increased focus on addiction and behavioral health, such as building a stronger workforce of care providers; and strengthen access to health care by offering more health centers in schools and training more primary care workers.
What’s next for Medicaid coverage?
As pandemic-era Medicaid coverage is “rolled out” over a one-year period, advocates fear that even more people could lose health coverage entirely during the transition from automatic to manual enrollment, which could impact their ability to access health care, Rohling McGee said.
This is definitely something we want to keep an eye on moving forward, to see what impact the cancellation has on people, Rohling McGee said. There may be some who are able to get coverage through their own employer or through a spouse’s employer, although many lower-paying jobs often don’t offer insurance or offer insurance with a deductible very high and a high cost sharing.
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The Ohio Department of Medicaid said it is referring those who lose benefit due to being deemed ineligible after the pandemic to navigators and managed care providers who can help them find affordable alternative health coverage.
Other pandemic-related programs are expiring or changing at the same time, Rohling McGee said, including food stamps (which offered families more “emergency allowances” during the pandemic, ending in February), which could also impact people’s ability to access fresh food and healthy food and increase financial stress.
We want to make sure programs like Medicaid stay in place, Rohling McGee said.
dking@dispatch.com
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