NEWS

Medicaid expansion helping many, but bills loom

Jona Ison
Reporter
Beth Whalen poses with her granddaughters in November.

Last Christmas, Beth Whalen was scrambling to pull things together, but not just for the holiday, for life in general.

Just over a week before Christmas, Whalen was called on to care for her then 4-year-old granddaughter. Prescription drug addiction had led Whalen's daughter to criminal decisions and being the getaway driver in a robbery.

"When my daughter was arrested, I was humiliated, ashamed, angry and heartbroken," Whalen said.

As a case worker, Whalen had been the one helping others find the resources to help ends meet, but now she was left trying to find them for herself. At the time, she made too much money for assistance, but due to changes in Medicaid that, in part, extended income eligibility, she was able to get coverage for her granddaughter. When her hours were cut at work, she also then qualified and was able to drop her insurance at work to lessen the impact on her income.

"I don't think people know they are eligible now so they don't fill out an application," Whalen said.

Whalen was one of nearly 650,000 Ohioans receiving Medicaid through expansion as of the end of October. And state officials report most of those Ohioans, like Whalen, are using the insurance, not just carrying it around.

“That (level of need) was shocking to us; just trying to figure out how people were getting these services before,” said John McCarthy, Ohio Department of Medicaid director.

Although costs associated with expansion are being paid for by the federal government, eventually Ohio will take on 10 percent of the costs. In the fiscal year that ended June 30, that would have amounted to more than $343 million.

Ohio has one year left to ensure it can pick up half of that — 5 percent of Medicaid expansion costs.

What care?

Jim Bennett, of Chillicothe, had been going to a free health clinic before getting Medicaid through expansion, largely due to his diabetes and difficulties in affording his insulin.

“I wasn’t taking it and my blood sugar was going crazy,” he said.

Within a few months of getting Medicaid in 2014, Bennett went to a check-up with his doctor and a urine test led to the discovery he had bladder cancer. He is one of about 40,000 Ohioans on Medicaid through expansion who has been diagnosed with cancer.

If it hadn’t been for Medicaid, Bennett thinks he may still be unaware of his cancer instead of being cancer free after two surgeries and intravesical immunotherapy treatment.

Since Bennett had Medicaid, that treatment was paid for through his Medicaid managed care plan instead of him relying on Adena Health System writing it off as charity care. Between 2013 and 2014, the hospital reported a 45 percent decrease in charity care, which its chief financial officer attributes to Medicaid expansion.

Statewide, the Department of Medicaid reports hospitals provided $646 million in charity care, which was a 60 percent decrease from 2013.

The amount hospitals were impacted by expansion varies by region and its service population. The rate of Ohioans on Medicaid varies widely by county, with a low of 8 percent of people in Delaware County on Medicaid to a high of 41 percent in Pike County.

According to the Ohio Medicaid Assessment Survey released in August, Ohio’s rate of uninsured is 8.7 percent, half what it was in 2012. As of October, more than a quarter of Ohioans — nearly 3 million — had Medicaid with 646,000 of them receiving it due to expansion.

And Medicaid records indicate they needed the coverage with 78 percent of people having claims related to chronic health conditions such as heart disease, diabetes or mental health disorders.

Getting healthy

Whalen's access to Medicaid has come in handier than she expected as health issues came on causing her to quit working. In July, at 46 years old, she had a heart attack. She thinks the choices she made before Medicaid to not take all of the medications prescribed to her because she couldn't afford them likely factored into her heart attack.

"(If the medication was) not a necessity, not for my blood pressure or diabetes, I didn't take it ... I wonder how much not taking cholesterol medicine led to my heart attack," Whalen said. "Now (with Medicaid) I'm taking them. These medications that keep you alive, I can't imagine people who have an insurance without a prescription care or no insurance at all."

As of September, 67 percent of people covered through expansion had made a claim for a preventive health visit and more people, like Whalen, are taking medications as prescribed and doing necessary lab work, said Dr. John Gabis, a Chillicothe physician.

"Their access to care is much better," Gabis said.

Terry Russell, director of the Ohio chapter of the advocacy group National Alliance on Mental Illness, believes there is “probably no other illness that was impacted more (by Medicaid expansion) than mental health.”

As of September, more than 300,000 people across Ohio insured through expansion had a behavioral health condition indicated by diagnosis, service or prescription, said Sam Rossi, Ohio Department of Medicaid communications director.

Dr. Mark McGee, the medical director at the state mental health hospital in Athens, said expansion has helped his staff better connect patients to continued care after release, whether that’s getting medications, counseling or basic healthcare.

Growing costs

The numbers of Ohioans coming onto Medicaid through expansion has slowed, typically increasing 1 percent a month this year before decreasing by a percent in November.

Although the Medicaid assessment reports nearly 51 percent of Ohioans 19 to 64 years old receiving Medicaid are working and unemployment was at 4.5 percent in November, median wages in Ohio decreased in all but 13 counties between 2007 and 2014, according to Census Bureau data. If the trend continues, that could mean an even greater demand for Medicaid.

"Those (numbers) are already baked into our projections," McCarthy said.

Lately, those projections have been above actual numbers. The department finished the fiscal year in June $1.9 billion below the legislatively approved appropriation and overall Medicaid enrollment is 2.4 percent below projections so far this fiscal year, Rossi said.

Although down, expansion costs for the first five months of the current fiscal year were nearly $1.9 billion, more than half of last year's costs. Starting in 2017, Ohio will be responsible for 5 percent of the costs. Ohio's share will increase to 10 percent in 2020.

"It's no different (preparing for those costs) than the things we have been doing ... It's constant innovation and change," McCarthy said.

The department has been focused on transitioning more people to home and community-based care and providing reimbursement rates based on quality of care, he said. Currently, 80 percent of those on Medicaid are actually on one of five managed care plans, meaning a private insurer is directly managing the plan and claims instead of the state.

"Private insurance companies have the resources to run the program (better)," McCarthy said.

The shift, in his view, has meant greater efficiency and recipients get better care, like reminders to schedule cancer screenings and checkups, the state couldn't afford to provide. While too early to know if expansion is improving Ohio's mortality and disability rates, that's the hope.

"Ideally we need them to use and have healthcare and not be unable to work because of their health," McCarthy said.