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Ohio GOP Governor Pushes State Board to Approve Medicaid Expansion

By Rebecca Adams, CQ HealthBeat Associate Editor

October 11, 2013 -- Republican Gov. John R. Kasich, tired of waiting for GOP legislators to approve his plan to expand Medicaid, recently found a way to bypass lawmakers and asked a state board to vote at its Oct. 21 meeting to allow him to proceed.

The seven-member state Controlling Board's backing, which is likely, is the only hurdle standing in the way of Medicaid expansion in Ohio, said state officials.

Ohio would be the 27th local government, including the District of Columbia, to expand Medicaid. Pennsylvania also recently announced its intention to expand the program.

Kasich got a letter last week from the Centers for Medicare and Medicaid Services (CMS) allowing him to amend the state Medicaid plan to allow the state to broaden the Medicaid population to include people with income of up to 138 percent of the federal poverty level. CMS officials said they would pay for all the costs of the newly-eligible population starting on Jan. 1 for three years, as allowed by the health care law (PL 111-148, PL 111-152).

Ohio state law allows Kasich to use that strategy to amend the Medicaid program. It also permits state agencies to spend federal funds that have been approved either by the Ohio General Assembly or the seven-member state Controlling Board.

The board oversees state spending and must approve certain state expenditures. It's comprised of six legislators—four Republican and two Democrats—and one representative of the Office of Budget and Management who was appointed by Kasich.

Kasich asked the board to allow the state Medicaid agency to spend federal funds for the expansion through June 30, 2015. The request does not commit Ohio to using state funds for the expansion. After the first three years, the state would have to provide some money if it wanted to continue the program because federal funding phases down, eventually declining to 90 percent of costs for the new population in 2020.

The governor had hoped to convince the full legislature to sign off on a Medicaid expansion. But the House has resisted. State officials concluded that the best way to ensure that they could get the expansion started in January was to bypass the full legislature and go through the board.

"Only the General Assembly can authorize Medicaid to spend funds in this way, either through a bill or the Controlling Board," said Kasich spokesman Rob Nichols. "The administration has been preparing to implement this change when the General Assembly gives its OK [through the board] and we'll be ready."

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