by Chuck Hoven
Plain Press, November 2015 A panel of four people at a Medicaid Education Workshop held on October 20th offered answers to questions about Medicaid eligibility and what it covers; explained the various types of Medicaid programs; and offered an update about what is happening with Medicaid expansion in Ohio. Northern Ohioans for Budget Legislation Equality (NOBLE) and Community Partners for Affordable Accessible Health Care sponsored the workshop.
Gloria Aron, a member of Community Partner for Affordable Accessible Health Care, introduced those making presentations at the workshop. Panelists for the workshop were: Jacque Ward, Deputy Administrator of the Cuyahoga County Department of Job and Family Services; Trina Morgan, a mother of seven, a Medicaid Consumer, a member of Northern Ohioans for Budget Legislation Equality and United Clevelanders Against Poverty; John Corlett, Chief Executive Officer of Community Solutions; and Toshima Mathis, an application manager at the Free Clinic.
Deputy Administrator of the Cuyahoga County Department of Job and Family Services Jacque Ward brought a handout offering an overview of the Medicaid program which explains Medicaid eligibility under the new system in place in Ohio. She noted that, since Medicaid expansion in Ohio was approved under the Affordable Care Act, qualified individuals, ages 19 – 64, (those with income less than 138% of the federal poverty line, currently $1,305 per month) are now part of the expansion group. While single individuals now qualify for Medicaid under the expansion, they only receive basic Medicaid unlike families with children their coverage does not include vision and dental, said Ward.
Ward says her department is working to bring people who qualify under the new eligibility system into Medicaid. In addition to those that are newly qualified for Medicaid, due to expansion of the program, Ward says Medicaid health coverage for those that are income eligible includes coverage for parents, children and pregnant women; coverage for 19 & 20 year olds; coverage for families; and coverage for the elderly, blind and disabled.
Ward provided a handout titled Medicaid Overview, which indicates there are three new main categories of Medicaid: MAGI (modified adjusted gross income; Non-MAGI (primarily Aged, Blind and Disabled); and Special Medicaid Programs and Services. The handout describes the various amounts of income allowed for different situations.
For example, parents and caretaker relatives of children under age 19 can qualify for Medicaid insurance if their modified adjusted gross income is less than 90% of the federal poverty level; 19 and 20 year olds must have an income below 44% of the federal poverty threshold to qualify; and pregnant women with incomes up to 200% of the federal poverty line can receive assistance.
Non-MAGI ABD Medicaid for the aged, blind and disabled is available for those age 65 and older, the legally blind and persons who are determined disabled by the Social Security Administration. There are resource limits for this program of $1,500 for individuals and $2,250 for couples. Income for individuals should be less that $643 per month and for couples the income should be less than $1,100 per month. The handout indicates that certain deductions for medical costs may apply).
Ohio currently has a Spend-Down Program for persons eligible for ABD Medicaid with the exception that they are over the income limit. Under the Spend Down program, those individuals can spend down their income each month through medical expenses or purchasing coverage. They qualify for Medicaid when the amount of income left after subtracting their medical expenses is less than $643 for an individual or $1,100 for a couple.
The handout indicates that Medicaid also has a program to help people cover the cost of Medicare premiums and allows workers with disabilities to buy-in to the program. Workers with disabilities with incomes less than 150% of the federal poverty line are not charged a premium for this service. Those with incomes above that level must pay a premium.
Some of the Special Medicaid Programs and Services described in the handout provided by Ward include: Reinstatement of Medicaid for Public Institution Recipients; Family Planning Services (available until December 31, 2015); Long-Term Care Medicaid; Medical Coverage for Non-Citizens; and the Breast & Cervical Cancer Project.
There is also a program that provides temporary access to health services to people that appear eligible for Medicaid but have not yet completed the application process.
Ward noted Medicaid has a citizenship requirement – it is available to United States citizens and qualified non-citizens. Everyone in the program in Cuyahoga County must be a resident of the county and have a social security card. The packet Ward provided explained the various income requirements and resource requirements for the different types of Medicaid.
Ward said those who want to apply for Medicaid could get an application online at www.benefits.ohio.gov or call 1-800-324-8680. They can also come into an agency in person or mail in a paper application. Neighborhood Family Service Center locations include: Old Brooklyn, 4261 Fulton Parkway, 216-635-2918; Westshore, 9830 Lorain Avenue, 216-939-2523; and Virgil Brown, 1641 Payne Ave, 216-987-6968.
Medicaid Consumer Perspective
Trina Morgan, a Medicaid consumer, a mother of seven and a member of both Northern Ohioans for Budget Legislation Equality (NOBLE) and United Clevelanders Against Poverty offered some advise and comments about Medicaid. She recommended going in person to apply or get information about Medicaid. She says using the phone you end up waiting a long time.
Morgan praised the Medicaid health coverage for 19 & 20 year olds, which she called a “beautiful thing” which have helped her two daughters while they attend college. She says Medicaid coverage helps so they don’t have to choose between food and health care while attending college.
Morgan noted many low-income working people don’t realize that they qualify for Medicaid. She noted a number of services, which Medicaid had helped her family including paying for prescriptions and home visits by nurses.
Morgan also urged residents of Cuyahoga County to get rated at MetroHealth, which she called “a beautiful program” which helps reduce the cost of medical care. She noted that single individuals on Medicaid that don’t get dental and vision care could go to Care Alliance and a number of other programs for those services.
State budget concerns
John Corlett, Executive Director of Community Solutions, talked about a proposal being considered by the Ohio Legislature that concerns the Medicaid program. He said one provision in the State of Ohio Budget would require nearly every adult receiving Medicaid to enroll in a health savings account. Corlett says the proposal by the legislature requires the Ohio Medicaid director to seek a federal waiver that would allow Ohio to require all non-disabled adults enrolled in Medicaid to have a Health Savings Account. Corlett said the Medicaid recipients would be required to deposit 2% of their family income into the account up to a $99 annual limit. The proposal calls for those not making payment to lose their Medicaid.
Corlett says there is a dangerous trend that is trying to equate Medicaid with welfare and requiring work to get Medicaid. He said Medicaid is not a welfare program; it is a health care program and a work support program that allows individuals to maintain their health so they can work.
While Corlett believes the Obama Administration would not grant the waiver to Ohio, he is concerned about the time line. He believes that it will take the State of Ohio Medicaid Department 9-12 months to submit the waiver application. This would mean it would be submitted from April to July of next year. There would then be a public comment period, which may mean the approval could be done by a new federal administration, said Corlett, stressing the importance of the next federal election.
Corlett says his experience has been that when you require co-pay, many low-income people will drop out of health care programs. He also noted that the state legislature talked about doing electronic transfer of funds to make the 2% payments. Corlett questioned whether most people with incomes below the poverty line even had bank accounts.
While six states have expanded waivers, Corlett said Ohio’s proposal is unique. He says Indiana has a proposal for Health Savings Accounts, only in the Indiana proposal people who don’t pay still get basic Medicaid (without vision and dental). “They don’t get cut off altogether like Ohio’s proposal,” he said. Corlett said Arkansas tried copay with cost sharing and eliminated the requirement because the cost to collect the money was more than what they collected.
Corlett said, “In Ohio we are a state that has already expanded Medicaid and we see that it is working. We are seeing health benefits. Why make it more cumbersome?” Corlett noted that currently the state of Ohio now gets reimbursed for 100% for the cost of expanded Medicaid. He said with the waiver, the state would only get reimbursed for 50% of the administrative cost, costing the state more than it is likely to take in.
Corlett said he believes both providers and Medicaid consumers will be hurt if the waiver proposed by the State Legislature is approved. “It makes sense to pay attention and testify as to what it will mean to Medicaid consumers,” he said. He noted that the waiver application is a public document and will have to be posted online. They will be required to make predictions as to what it will mean for coverage and they will have to take public comments.
Health Care Provider Perspective
Toshima Mathis, an application counselor at the Free Clinic, said the State of Ohio’s decisions about Medicaid would impact the Free Clinic as to the ratio of its patients with health insurance coverage. She said since Medicaid expansion in Ohio a number of working families now eligible for Medicaid have signed up. Mathis said the percentage of uninsured patients at the Free Clinic has gone down from 89% to 40%. She says the Free Clinic has helped 3,069 patients to apply for health care assistance and 2,153 applicants have successfully enrolled.
Mathis said people coming to the Free Clinic for medical care talk to her about the challenges they face making a choice between eating, paying household expenses or going to get the health care they so badly need.
Mathis says when people learn about Medicaid and the help it can provide, they are very happy when educated about what they can get. She says patients at the Free Clinic often tell her, “I never knew I was eligible for health care, or could get food stamps.”
Mathis says, “People thank me” for helping them get on Medicaid. She recounts a patient telling her, “I may have been on the verge of stroke – if I hadn’t gotten medication for blood pressure in time.”
Mathis said for uninsured patients the Free Clinic does have a sliding fee schedule. She said if the state requires co-pay, the Free Clinic could help people to make payments.
Mathis says the Free Clinic will be hosting an open enrollment on November 7th where they will be screening patients for Affordable Health Care and Medicaid and offering enrollment information they need.
Questions about programs
Several people in the audience raised questions about the Spend-Down program and plans in Ohio to move people on the Spend Down program to the health care exchange to seek health insurance.
Ward noted that spend-down is going to go away, but not dual eligibility. So people that are eligible for both Medicare and Medicaid will continue to have Medicare as their primary coverage and Medicaid as supplemental.
Ward said for people on the 1634 version of Medicaid (recipients of Supplemental Security Income that automatically qualify for Medicaid) already do not have a spend-down program. She said the State of Ohio has chosen not to have a spend-down program and instead moved the income limit to qualify for Medicaid $91 higher than it is now. She said this would be helpful to a number of people that have incomes under the new limit that will now get full coverage. Those with incomes above the new threshold will have to go to the health care exchange formed under the Affordable Care Act.
Corlett noted that people who are using spend-down are very sick and have a lot of health care costs. These are people who are getting coverage that otherwise would not get coverage. “We need to educate people to make transition to the exchange,” he said.
There was some discussion that coverage on the exchange would not be as good as Medicaid and that Cuyahoga County residents with incomes up to 400% of the federal poverty line can get rated at MetroHealth to get coverage on a sliding scale. It was also noted that federally qualified health clinics would help patients to pay for prescriptions.
Another issue raised was that of behavioral health services. John Corlett noted that in the past behavioral health services were billed on a fee for service basis. Now plans call for those services to be rolled into managed care programs. The same is true for care for children in foster care. Corlett expressed concern about the impact this will have on behavioral health care consumers. He says generally it takes a longer time for these health care consumers to build up a relationship with a caregiver and it is more difficult for them to switch providers.
In closing the meeting, Gloria Aron urged those present to continue to monitor changes in the spend down program, the movement of behavioral health services to managed care and the State of Ohio’s waiver application to set up Health Savings Accounts for Medicaid recipients. Referring to the proposed waiver application, Aron said, “Knowledge is power. Everyone in this room can take power and come together as a community and taxpayers and say to legislature this is not in our best interest. Not in our best interest if they are going to change a program and a member of our community is not going to get services, or will get less service. We in this room can be the catalyst for change.” Aron then urged those present to attend an upcoming meeting of NOBLE to discuss Medicaid policy in Ohio.