By: Susan Tebben – Ohio Capital Journal

From changes to Medicaid to cuts to pediatric cancer research, the Ohio House budget proposal concerns many who have championed child wellbeing and improvement on issues where Ohio struggles — like infant mortality — as important budget priorities.

“It just felt like they had taken a hacksaw to some of these line-items without real consideration to what they did,” said Kathryn Poe, budget and health researcher for the think tank Policy Matters Ohio.

Poe said it seems as though state legislators are taking cues from the federal government are trying to drastically cut spending, but that don’t improve the state in the process.

“These cuts at the federal level also feel really haphazard,” Poe said. “But the state doesn’t have the amount of money or time or influence to make these sort of haphazard cuts.”

Specifically, Poe sees the elimination of Ohio’s Medicaid expansion as a significant change that will create struggles for low-wage workers who count on Medicaid for their health insurance, and who will be prevented from planning for the future without the ability to count on proper health insurance.

As Poe put it, “what do you do when 700,000 people lose their insurance overnight?”

The House’s version of the budget absorbed a proposal by Gov. Mike DeWine in his executive budget that creates a trigger effect, eliminating Group VIII, or the Medicaid expansion eligibility group, “if the federal government sets the federal medical assistance percentage below (its current level of) 90%,” according to budget documents.

The federal medical assistance percentage (or FMAP) refers to the amount of federal funding the state receives for Medicaid, based on a state’s per capita income.

 

The expansion group is made up of Ohioans ages 19 to 64 who have household incomes of less than 138% of the federal poverty line and aren’t eligible in other Medicaid categories. According to the Health Policy Institute of Ohio, the Medicaid expansion “has been a major contributor to Ohio’s uninsured rate dropping by half from 14% in 2010 to 7% in 2022.”

The group said the expansion has also improved access to care, with data showing a 31% decrease in Ohioans who went without care due to cost from 2013 to 2023.

According to the state, the expansion population caseload is projected to be 779,000 Ohioans in fiscal year 2026, and 772,000 in 2027. That would account for more than $13.5 billion in expenditures over the two fiscal years.

Without the expansion, workers under the program would be less likely to have insurance, partly because many workers earning less than 138% of the federal poverty line are working jobs where they aren’t given enough hours to receive medical benefits, such as entry-level retail jobs or customer service.

Citing data from the U.S. Bureau of Labor Statistics, the Health Policy Institute of Ohio said even workers in the skilled trades like electricians and medical assistants could lose benefits, considering the federal poverty level of 138% for a family of three represents an annual income of $36,777.

“It would be a devastating economic loss,” Poe said. “The answers (for Ohioans who would lose the coverage) are everything from going to the emergency room, to not getting care, to letting that pain in your abdomen go on so long that you have to go to the emergency room anyway.”

The budget proposal comes amid attempts by DeWine and the state to apply work requirements to that particular group of Medicaid participants.

Not only will it create expensive health decisions, but the ripple effects will extend to the ability to afford groceries or have reliable transportation, according to Poe.

Those effects would trickle all the way down to Ohio’s children as well, according to advocates. Groundwork Ohio criticized a House measure that would end a requirement that the Medicaid department “seek approval to provide continuous Medicaid enrollment for Medicaid-eligible children from birth through age three

Budget documents say the change could create “possible service cost savings.”

Groundwork called on the legislature to take back the changes, saying nearly 48% of all Ohio children under the age of 6 “depend on Medicaid for health coverage.”

“The program covers about half of all births in the state and thousands of Ohio women rely on Medicaid to ensure a healthy pregnancy and support postpartum recovery,” according to an analysis of budgetary proposals in the House draft.

The organization also criticized a provision of the budget that would limit Medicaid coverage for doulas, leaving the coverage for only the six counties with the highest infant mortality rates.

The House plan also cuts pediatric cancer research by $5 million and eliminates lead abatement programs within the Ohio Department of Health. Groundwork Ohio noted the lead abatement program as part of their analysis of the budget plan, saying Ohio has “nearly double the national rate of children with elevated blood lead levels.”

“Even small amounts of lead exposure in early childhood can harm the brain, delaying growth and development, and may cause learning, behavior, speech and other health problems,” the group stated.

Advocates have already been publicly critical of the House plan to slash public education funding and drop a child tax credit proposed by DeWine in his budget plan. But adding the Medicaid changes, along with reducing funding in the areas of child development and a $1.5 million cut to “infant vitality” programming just make things worse, advocates say.

“The House’s proposal represents a step backward at a time when we can least afford it,” said Lynanne Gutierrez, president and CEO of Groundwork Ohio, in a statement. “We urge lawmakers to fully restore these investments and prioritize Ohio’s future.”

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