Guest columnist John Corlett is the president and executive director of The Center for Community Solutions. Corlett’s career has included leadership roles in both the public and private sectors, including serving as vice president for government relations and community affairs at The MetroHealth System and as the State of Ohio’s Medicaid director.
On Jan. 14, 2019, Mike DeWine will be sworn in as the 70th governor of Ohio. Three months later, he will have to submit his first two-year budget proposal to the Ohio General Assembly. One issue likely to get a lot of attention in this first budget is Medicaid -- the single largest source of health-care coverage in the state -- covering one out of four Ohioans.
For nearly four years, most of Medicaid’s legislative and political focus in Ohio has been on its expansion, which was part of the Affordable Care Act. It has consumed much of the energy of the Ohio Department of Medicaid and created a division between Gov. John Kasich (a strong proponent) and the sizable number of Republican legislators who oppose it.
John Corlett, president and executive director of The Center for Community Solutions. (Photo Courtesy of The Center for Community Solutions)
DeWine has said he supports continuing the Medicaid expansion if it is accompanied by a “reasonable work requirement” and “a wellness program.” The Kasich administration has already submitted a request to the federal government to approve work eligibility requirements, and a federal decision on that request could come soon. The question is whether new limitations on the expansion of Medicaid, if approved, will be enough for a majority of Republican legislators to finally support the program.
Of course, even if the limitations are approved, the new governor will still have expansion policy questions to address. The new administration will have a score of implementation issues, including whether counties will be expected to bear the cost of carrying out the program. Both the State of Ohio and The Center for Community Solutions have estimated these costs would be in the tens of millions of dollars.
DeWine’s wellness goals might be implemented more easily through Ohio’s existing Medicaid managed-care program, by increasing pay for performance, withholding and/or re-negotiating existing contracts to include a wellness component.
But Ohio would be wise to focus any wellness efforts on reducing smoking. Recent data shows that nearly half of all working-age Ohio Medicaid beneficiaries smoke -- some even while pregnant. Massachusetts Medicaid implemented an evidenced-based cessation plan that reduced beneficiary smoking by 26 percent in two years. A successful effort in Ohio could pay similar dividends.
The best opportunity for changing the Medicaid policy debate could come from placing a sharper focus on the needs of children. This need was underscored by a recent report from the Georgetown University Center on Children and Families that showed that the number of uninsured children in Ohio grew by 21,000 in 2017 to a total of 125,000.
Reducing the number of uninsured children in Ohio has always been a bipartisan priority because of the connection between health-care coverage and success in school and life. Indeed it was the late Gov. George Voinovich -- with DeWine as his lieutenant governor -- who pushed through some of the earliest expansions of children’s health-care coverage in Ohio.
Many child advocates welcomed the fact one of the very first appointments announced by DeWine was LeeAnne Cornyn as his director of children’s initiatives. This sent a clear message that children’s health, both behavioral and physical, will get increased attention from the new administration. Cornyn will report directly to the governor and will coordinate children’s programs across all state agencies.
One of the largest existing and potential funders of children’s programs in Ohio is the Medicaid program. So it will be critical for the new administration to quickly get a handle on these programs and their performance so they can be focused on providing an opportunity to every Ohio child -- despite their circumstances, health or disability.
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