Ohio’s Medicaid enrollment has declined more than 8% in the past two years, raising questions about whether the more than 250,000 former beneficiaries have become uninsured or found other health coverage.
According to the Ohio Office of Budget and Management, Medicaid enrollment has fallen in 23 of the past 24 months. More than three fourths of those leaving the rolls were adults while the rest, some 60,000, were children.
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A recent analysis by the Kaiser Family Foundation found Ohio had the fourth highest drop in the nation in 2018, behind Tennessee, Missouri and Arkansas.
The question is: why?
Medicaid Director Maureen Corcoran points to a couple of reasons enrollment has declined: an improving economy, and “systems issues,” including a sometimes-clumsy computerized renewal process that beneficiaries must complete every year to maintain coverage.
As the economy has improved and unemployment has dropped, Corcoran said, some people’s incomes have grown and they no longer qualify for coverage because they exceed eligibility limits — annual income up to 138% of the federal poverty rate for adults and 200% for children.
And a number of beneficiaries lose coverage during the annual renewals, removed from the rolls after failing to provide information confirming their continued eligibility.
Health policy analysts say a better economy may be contributing to but cannot account for such a sharp decline. They believe the primary cause is a time-consuming sign-up and renewal process, which has drawn federal scrutiny, and a reduction of enrollment assistance.
As Medicaid rolls fall, the uninsured rate has been rising.
In Ohio, the uninsured rate fell significantly following Medicaid expansion in 2014 under the Affordable Care Act, but has begun to climb. About 6% lacked health coverage in 2017, the most recent data available, reflecting a slight increase for both adults and children.
Minority Democrats in the Ohio House are demanding answers, pointing to the 37,000 children who have left Medicaid rolls, a 3 percent drop, during a 15-month span ending in April.
“These decreasing numbers are especially concerning because we have worked so diligently over the last decade to increase the number of insured children because we know there are long-term consequences to children’s health and attainment when they lose access to quality, affordable health care,” Rep. Allison Russo, D-Upper Arlington, wrote in a recent letter to Corcoran signed by 25 lawmakers.
“Children without consistent health care are more likely to perform poorly in school and face negative long-term consequences in health, education and financial well-being.”
Corcoran said she’s encouraged to see Medicaid enrollment among children has leveled off in recent months. Still, she says there are eligible children who have lost coverage.
“As more adults come off (Medicaid), they are not likely signing their kids up for coverage even if they remain eligible,” Corcoran said, noting that income caps for children are higher than their parents.
Amy Rohling McGee, president of the Health Policy Institute of Ohio, said she believes that Medicaid enrollment has dropped because the sign-up process is complicated and confusing and people don’t enroll if they don’t have immediate health needs.
She noted that Ohio’s uninsured rate for adults age 18-64 with incomes below 138% of the poverty level — meaning they are eligible for Medicaid — is 14.4%, compared to just 3% for people with incomes above 400% of the poverty threshold, who are more likely to have employer-sponsored coverage.
“It indicates that low-income people are not signing up for Medicaid unless they need it,” McGee said.
Rohling McGee was skeptical that many people leaving Medicaid were getting private coverage as a job or increased income doesn’t necessarily come with health benefits. While the uninsured rate inches higher, the percentage of non-elderly adults with employer-sponsored coverage in Ohio is unchanged in recent years at 54%.
Corcoran said surveys of former beneficiaries suggest some have gotten other insurance but many have not, and about a third come back on Medicaid rolls, supporting the contention that people sign up when they need care.
Meanwhile, Corcoran said the state is working with federal regulators to resolve lingering problems with an automated Medicaid enrollment and renewal system launched in 2014, including a backlog of applications and high rate of eligible people losing coverage.
“We’re trying to make the process easier,” she said.
Steven Wagner, executive director of the Universal Health Care Action Network of Ohio, suggested another reason for the decline in Medicaid enrollment, as well as a drop in the number of people who purchase individual insurance coverage through exchanges created under the Affordable Care Act.
“The significant reduction in enrollment assistance and advertising almost certainly played a role in the increase in uninsured,” he said.
President Donald Trump’s administration slashed federal grants for groups that help people sign up for Obamacare along with deep cuts in advertising funding during the fall open enrollment season.
According to federal data, 206,871 Ohioans obtained coverage through the exchange in 2019, down 15% since 2016.
ccandisky@dispatch.com
@ccandisky