Ohio Medicaid expansion in early innings

It’s too early to tell whether expanding Medicaid in Ohio is living up to its promise of offering health insurance coverage to hundreds of thousands of low-income residents, but it’s clear that many of southwest Ohio’s most vulnerable residents are being drawn to the program with hopes of a better future.

Patricia Burdine of Franklin informed her son, Jeffery Noble, he could sign up for Medicaid through the HealthCare.gov website after she discovered he could qualify this year under new eligibility rules established by the Affordable Care Act and enacted in 36 states, including Ohio.

Noble, 42, is unemployed and doesn’t meet the income threshold to qualify for government-subsidized private health plans, also offered through the federal website. And as a single, adult male, Noble — who now lives with his mother — wouldn’t have qualified for Medicaid under the old eligibility requirements, which limited the program mainly to the disabled and pregnant women.

“He had a good job, making good money with benefits before he lost his job through no fault of his own,” Burdine said. “I was always brought up to believe that if you can work, you work. But if you can’t, you shouldn’t have to go bankrupt trying to cover your health care costs.”

In states like Ohio, Medicaid coverage has been extended to anyone earning up to 138 percent of the federal poverty level, or just under $16,000 last year.

Noble is among 48,971 Ohioans who have been determined eligible for Medicaid or CHIP, the Medicaid program covering children, through the HealthCare.gov website, according to the latest figures from the U.S. Department of Health and Human Services.

But because of continued technical glitches with the federal website, the government hasn’t transferred those applications to the state for approval, leaving Nobel and others in limbo — although their coverage will begin retroactively on Jan. 1 once their applications are approved by the Ohio Department of Medicaid.

Ohio Medicaid has approved an additional 20,338 applications through direct enrollment on its Benefits.Ohio.gov website.

But the applications include the newly eligible as well as re-enrollments and people who previously qualified for Medicaid but did not enroll for some reason, making it hard to determine how much interest is due to the health care law.

The expansion is expected to cover about 275,000 newly eligible enrollees by June 2015, according to Medicaid Ohio officials, who will release detailed information about then newly eligible population next month.

Still, a spike in enrollment because of the health care law is nearly inevitable, expert say.

The question is what kind of impact will all those new enrollees have on the health care system, said Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association.

The hope was that Ohioans gaining coverage through the Medicaid expansion would seek preventive care that could keep them out of hospital emergency rooms, where the cost of care is most expensive and has contributed to rising medical costs for everyone, Bucklew said.

But so far, there is little evidence that expanding Medicaid is having the desired effect. In fact, case studies in states that have already expanded Medicaid suggest emergency department visits increase, at least initially, for people who were previously uninsured or have pent-up health care needs, Bucklew said.

In addition, many new Medicaid patients have never developed a relationship with a regular family doctor and are unaccustomed to seeking medical attention unless they have an acute illness or injury.

“The long-term goal is getting people out of the emergency room, and getting them the right care at the right time at the right facility,” Bucklew said. ““But I don’t think that’s realistic in the short term.

“For so long, often the first and last resort for many people for getting any kind of health care has been the emergency room,” he said. “Trying to change consumer behavior in regards to health care can be very challenging.”

Still, rising Medicaid enrollment could offer some immediate benefits, including helping to alleviate the financial burden on hospitals for providing so-called charity or uncompensated care to the uninsured.

The expansion of Medicaid means that thousands of previously uninsured patients who regularly visit emergency departments will now have at least some form of coverage.

“In theory, if you have more people covered, you’re going to have less uncompensated care,” Bucklew said. “But it’s not like uncompensated care is going to drop to zero overnight.”

Any reduction would be significant.

The American Hospital Association reported earlier this month that the cost of uncompensated care, or care for which no payment is received, rose 11.7 percent in 2012 to $45.9 billion and accounted for about 6 percent of hospitals’ total expenses — the highest percentage in more than a decade.

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