The Center for Health Affairs, a nonprofit organization representing Northeast Ohio hospitals, is pleased to serve as a community partner for the City Club’s program with former Medicaid director Cindy Mann, “The New Medicaid.”
For decades, mothers, children, disabled workers, and childless adults found health insurance to be extremely expensive and unattainable. Thankfully, with the passage of the Patient Protection and Affordable Care Act (ACA), millions of Americans were finally granted access to healthcare coverage and, since its implementation, Ohio’s uninsurance rate for adults has dropped to only 7 percent, according to a recent report by the Center for Community Solutions.
The ACA changed a number of components in the health insurance market to assist those earning less than 400 percent of the Federal Poverty Level (FPL). For many, the ACA supplements the cost of health insurance by providing a subsidy to purchase a suitable plan on the Federal Marketplace. Those earning below 138 percent of the FPL − $16,243 for an individual or $33,465 for a family of four – are now qualified for Medicaid coverage under the ACA if they reside in one of the 32 states, including D.C., which made the decision to extend coverage.
In Ohio, proponents of extended Medicaid coverage from across the state came together to convince lawmakers to provide vulnerable residents with access to healthcare services. While the General Assembly did not muster the votes to approve this measure, Governor Kasich was successful in utilizing Ohio’s Controlling Board to accept federal funds. Leading up to its passage, initial figures by outside research institutions estimated 370,000 residents would gain access to health coverage under extension, including over 95,000 right here in Northeast Ohio. Since 2014, when the program was first extended, Medicaid coverage in Ohio has grown beyond even the most ambitious estimates – now covering over 650,000 Ohioans as of November 2015.
Today, Medicaid is the single largest insurer in the state, covering nearly 3 million Ohioans. And, while eliminating barriers to care and creating additional opportunities to access healthcare is a crucial, the Ohio Department of Medicaid (ODM) has also done a significant amount of work to tackle issues such as quality and cost.
Evidence suggests that newly covered patients are actually using their coverage wisely and more efficiently. Today, in Ohio’s new Medicaid, 65 percent of covered individuals had a preventive visit. In many ways Ohio’s Medicaid program is building upon the success of the 2013 MetroHealth Care Plus program, an 1115 Demonstration project approved by the U.S. Centers for Medicare and Medicaid Services which enrolled roughly 30,000 Cuyahoga County residents in healthcare coverage. Heavily relying on the medical home model, MetroHealth’s Care Plus model more effectively managed patients’ high blood pressure and diabetes when compared to uninsured patients.
Building upon the same medical home concept, the ODM has worked with the state’s managed care organizations (MCOs) to better coordinate care with enrollees. Today, 4-in-5 individuals are covered by an MCO. Now charged with managing the care of large pools of beneficiaries, MCOs are working with the ODM to improve outcomes through various pay-for-performance (P4P) programs. Beginning in 2014, MCOs are eligible for bonus payments based on their performance on the P4P metrics – further incentivizing low cost, high quality delivery systems.
Further payment reforms are occurring within the Medicaid program as well. Since 2013, Ohio has been awarded two rounds of grant funding from the Centers for Medicare and Medicaid Services State Innovation (SIM) Model, which will be used to expand the use of patient-centered medical homes and launch episode-based payments for high-cost medical events. Over the course of the next several years, the State of Ohio has adopted an ambitious goal to enroll 80-90 percent of the total population in value-based payment models, including both Medicaid fee-for-service and managed care.
As the Medicaid program has continued to evolve, providers across the state and here in Northeast Ohio have skillfully adjusted to change. Hospitals are focusing more than ever on encouraging appropriate use of the emergency department and ensuring patients receive care in the most appropriate setting. And it’s paying off – across the region patients are beginning to receive the right care, in the right place, at the right time.
One thing is undeniable: today, millions of Ohioans rely on the Medicaid program to ensure the health and well-being of their families. In Northeast Ohio we are especially proud to have institutions that have come together to serve these patients and ensure they receive the care they deserve.
The Center for Health Affairs is proud to be a community partner for this event, and excited to be a part of such an important discussion. We’re optimistic that community conversations such as this will only further strengthen the commitment of providing care to the most vulnerable among us, for this generation and generations to come.