CLEVELAND, Ohio — Ohio public policy experts are divided on the Trump administration’s new Medicaid block grant program, which is designed to give states more flexibility in Medicaid spending, but cap a portion of federal contributions.
Opponents of the plan, which was introduced Jan. 30, say it will cut benefits and enrollment.
Supporters say it will help control costs and give states more flexibility over Medicaid dollars.
Today, we at CMS are excited to announce the new Healthy Adult Opportunity – an optional #Medicaid demonstration that gives states a full array of tools to design accountable health coverage programs tailored to the unique needs of adult beneficiaries. https://t.co/cydWEI7PmH
— Administrator Seema Verma (@SeemaCMS) January 30, 2020
Loren Anthes, public policy fellow for Community Solutions, a Cleveland-based think tank, said block grants are “just code for making cuts.”
“I think that the policy consequences associated with this proposal are dramatic and err on the side of less coverage, less benefits and greater chance for economic disruption for individuals and for whole communities,” Anthes said.
Rea Hederman Jr., executive director of the Economic Research Center and vice president of policy at The Buckeye Institute, on the other hand, called the block grant waiver “a new tool” to manage the Medicaid program and said it is worth exploring.
The program, called Healthy Adult Opportunity, allows states to apply for a waiver to receive a fixed block grant for Medicaid costs, using either an aggregate cap or a per-capita cap for federal Medicaid contributions. Currently, states receive matching funds, known as Federal Medical Assistance Percentages, from the federal government for Medicaid costs.
To participate in the HAO program, states need to apply for what is known as a Section 1115 demonstration waiver. These waivers allow states to test new ways to deliver or pay for Medicaid services. For example, Ohio in 2019 was approved for a waiver allowing the state to impose work requirements on the Medicaid expansion population – able-bodied adults without dependents.
“I think the state should absolutely have a conversation with the federal government to unpack some of the ideas and the guidance,” Hederman Jr. said. “Any time you have a new tool like this, it makes sense to understand whether this tool helps you in your work.”
Ohio Medicaid Director Maureen Corcoran told The Columbus Dispatch on Feb. 12 that she doesn’t plan to apply for block grant funding at this point.
In Ohio, about 3 million people are on Medicaid, about 600,000 of which were covered through the state’s 2014 Medicaid expansion. The plan only applies to the Medicaid expansion population and doesn’t include children, pregnant women, elderly adults and people with disabilities.
Under HAO, states would be able to make changes to Medicaid, such as limiting benefits for enrollees, imposing higher co-pays on drugs and doctor visits and controlling which drugs are covered.
Anthes characterized those options as “the sorts of things that make the benefit harder to access and less meaningful.”
“I believe it’s been a very intentional policy position of lawmakers who do not like Medicaid as an entitlement that the way to disrupt or end the entitlement is through these sorts of mechanisms,” Anthes said.
Hederman Jr. said disenrollment is not a part of the plan and that the proposal is “aimed at delivering Medicaid services more efficiently.”
“This is not your traditional Republican block grant idea of 20 years ago. It’s a lot more limited in scope with a lot of safeguards put in place. It’s very clear that you still have to offer the required amount of benefits,” Hederman Jr. said.
Because the plan was rolled out by the Centers for Medicare and Medicaid Services and not through the legislative process, Anthes and Hederman Jr. both expect any proposed state waivers to be challenged legally, as was the case with Medicaid work requirement waivers. On Feb. 14, a federal appeals court struck down the Trump administration’s decision to permit Medicaid work requirements in Arkansas.
More health stories:
Death of Lake County 11-year-old is the second flu-related pediatric death in Ohio
New SNAP requirements, red tape could leave more Ohioans without food
Novel coronavirus less deadly than past epidemics, local experts say
‘I basically have to stay sick:’ NE Ohioans feel the costs of delaying health care
Medicare reimbursement change altering how skilled nursing facilities provide therapy