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Debate on Medicaid's future awaits Ohio lawmakers


COLUMBUS, Ohio (AP) — Ohio lawmakers will return to the Statehouse next month faced with whether to make changes to Medicaid, the federal-state health program for the poor and disabled.

Republican Gov. John Kasich wants to see the program expanded to cover more low-income residents under the federal health care law. But the GOP-controlled Legislature has balked at the idea despite the U.S. government promising to cover the entire cost of the expansion for the first three years and 90 percent for subsequent years. Roughly 366,000 Ohioans would be newly eligible for coverage beginning in 2014.

As legislators try to find common ground on how to change the program, here's a look at some of the questions and answers surrounding the Medicaid debate:

Q: Doesn't the governor have the authority to expand the program on his own?

A: Yes. His administration could expand Medicaid eligibility or seek federal approval to make other changes to the program.

Q: So what role does the Legislature play?

A: Kasich needs legislative approval to spend the federal dollars on the newly eligible Medicaid enrollees. State lawmakers could pass a bill that allows the federal money to be spent on the new Medicaid population. But several bills that would do so have so far gone nowhere in either chamber. A seven-member panel that handles certain adjustments to the state budget, called the Controlling Board, also could vote to authorize the spending.

Q: Is spending authority important to expanding Medicaid?

A: Yes. Without it, there wouldn't be enough money in the state's two-year budget to cover more people in Medicaid. The program would likely have a cash-flow problem and possibly not enough money to pay health care providers for serving Medicaid patients.

Q: What are some of the hang-ups in the Legislature?

A: Medicaid expansion is one of the key components of Democratic President Barack Obama's health care law. Many Republican lawmakers, who dominate both chambers of the General Assembly, are averse to the health overhaul and resistant to expanding government programs. They have cited concerns about increasing the national debt and fears that the money from Washington could be cut off. Medicaid already provides coverage to one of every five residents in Ohio.

Q: What about letting Ohio voters decide if the Medicaid should be expanded?

A: Health care advocates are working on a proposal that could put the issue to a statewide vote in November 2014. The effort must first clear several steps to be successful. The backers must gather signatures of at least 3 percent of the total votes cast for governor in 2010, or 115,574. Once those are verified, the General Assembly has four months to act on the proposed law. If legislators pass, amend or take no action, then a supplemental petition may be circulated before voters next year.

Q: Is there a federal deadline for the state to pass expansion?

A: No. But state officials have said a Medicaid extension needs legislative sign-off by late summer or early fall to give time for people to be covered by January.

Q: What happens if Ohio doesn't expand Medicaid this year?

A: The state will lose out on getting the maximum amount of federal dollars available. How much? Depends on who's counting. The Urban Institute estimates Ohio would miss an average of almost $5.5 million a day in the first year, while The Ohio State University projected that the federal money not coming into the state could be closer to about $7.3 million a day. The figures were part of a study from the Health Policy Institute of Ohio, Ohio State, the Urban Institute and Regional Economic Models Inc. Federal funds from an expanded Medicaid also would generate additional state revenues in other ways, which Ohio would lose out on.


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