Saturday, Sep 22, 2018
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Try again on Medicaid


The federal Centers for Medicare and Medicaid Services said no to Healthy Ohio last week.

The state program with that name would have required Medicaid recipients to make monthly contributions to a form of health savings account; the state would have contributed a baseline $1,000 a year, plus incentive payments to reward healthy behavior. The end of this proposal should not be the end of the goal of giving Medicaid beneficiaries a bigger stake in controlling costs and improving their own health.

Healthy Ohio, which the state legislature included in the current budget, embodied some good ideas. The more of a stake people have in controlling their own health-care costs, the more they’ll help control them.

The program would have helped prepare people to leave it. The ability to take the account balance with them and use it to pay premiums for private health insurance could have eased some users’ transition out of Medicaid. And the use of the accounts to pay for medical services while on Medicaid could have given at least some beneficiaries a bigger incentive to limit their medical costs, helping them develop a habit that would have been good for the state while they remained on Medicaid and good for them once they got off it.

Yet the program may have gone too far; it clearly went too far for the federal officials whose approval it needed. In rejecting the proposal, acting CMS administrator Andrew M. Slavitt objected to requiring anyone, “regardless of income,” to pay, and to cutting off those who fail to pay until they make good their arrears.

For a few of the neediest Ohioans, the contributions — 2 percent of income or $8.25 a month, whichever was less — may have been unfeasibly steep. And even when it comes to those who could have paid, it would take a lot to justify forcing them to make contributions that could be painfully expensive for them without being enough to make a meaningful difference in the actual cost of providing them services.

In a letter to legislators, Ohio Medicaid director John McCarthy said his agency had warned that the Healthy Ohio proposal the General Assembly created, which differed significantly from Gov. John Kasich’s proposal to require some Medicaid recipients to pay premiums, might not be approved. He said he wanted to work with legislators to make sure Ohio Medicaid promoted personal responsibility.

The CMS is open to a new proposal, and Ohio should submit one. In crafting the new proposal, legislators and the Kasich administration should continue to seek ways to give Medicaid recipients a smoother path off Medicaid and a bigger stake in reducing health-care costs while they are on it. They should continue to add incentives for healthy behavior, perhaps requiring beneficiaries over a certain income to either complete wellness programs or make monthly payments. Healthier Medicaid patients would help to significantly defray costs in the system. So there is another path to responsibility.

At the same time, Ohio government should take care to be less harsh on the poorest and most desperate Ohioans. And they should strive to create a program that will win federal approval.

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