Kasich Will Try End-Run To Expand Medicaid In Ohio

Ohio Gov. John Kasich will make a unique end-run around the state Legislature to expand the state's Medicaid program under the Affordable Care Act.

Kasich has in the works a request for Medicaid expansion through the Ohio Controlling Board. It is a seven-member body that handles funding requests from state agencies, including Ohio's Medicaid department.

According to a pending appropriations request drawn up late last week, Ohio Medicaid Director John McCarthy is asking the Controlling Board for a $561.7 million additional Medicaid appropriation for the rest of fiscal 2014, and $2 billion request for fiscal 2015. The request was submitted just days after the Centers for Medicare & Medicaid Services authorized Ohio to expand its program along guidelines Kasich had submitted.

The board plans to vote on the request at its next meeting on Oct. 21. Four votes would be required to approve the expansion.

“I prefer not to legislate through the Controlling Board, but the truth of the matter is that there are any number of proposals that have come through the Legislature,” said Sen. Tom Sawyer, a Democratic appointee to the board. “It’s not as though these matters haven’t been considered prior to this by the Legislature.”

The board, which has been in existence since 1915, has an appointee from the state Office of Management and Budget, whom Kasich appointed; high-ranking members of the both the House and Senate Finance Committees; and Democrats and Republicans from both the House and Senate.

The two Democrats who serve on the board are expected to vote in favor of expansion. Two Republicans currently on the board are expected to be replaced by individuals in support of the plan by House Speaker Bill Batchelder, sources said.

“It really becomes a smaller subset of the Legislature,” said Rep. Barbara Sears, a Republican whose attempts to get Medicaid expanded have been frustrated for nearly a year. “The Controlling Board becomes what we backed ourselves in the corner to do.”

The board has handled controversial funding requests before. It approved Ohio's accepting of economic stimulus funds in 2009 after the Generally Assembly balked at doing so.

Greg Moody, director of Kasich's Office of Health Transformation, has told various media outlets in Ohio that the board has the authority to expand federal funding.

Kasich, a Republican, has been advocating for Medicaid expansion but has been unable to convince lawmakers to sign off on a plan. That makes Ohio the most populous non-Southern state to not adopt a Medicaid expansion plan. Michigan's Legislature recently okayed a plan for expansion that would require enrollees to switch to private coverage or have co-payments after four years on the rolls, putting more pressure on the Buckeye State to follow suit.

Ohio's hospitals have discussed placing the question of expansion to voters, but has yet to move forward with such an initiative.

Medicaid expansion in Ohio would provide coverage to more than 360,000 low-income residents who would likely be too poor to afford purchasing their own insurance and would also not qualify for premium subsidies through the state's health insurance exchange. The federal government would pay 100% of the cost of expansion through 2016, and 90% in the years after.