John Kasich’s administration has been marked by some of the most significant and impactful policy changes in Ohio’s Medicaid program during its history. Before the governor took office, there was no Medicaid expansion, Medicaid was under the purview of the Ohio Department of Job and Family Services and the beginnings of the opioid crisis were just taking hold. In the eight years since, Medicaid has cemented its place as one of the most consequential policy endeavors of the state, serving as a key catalyst in reforming Ohio’s health care delivery system and addressing key public health challenges like infant mortality.

Today, Medicaid is responsible for making Ohio’s uninsured rate the lowest it’s been in the state’s history while serving as a platform for new ways of reimbursing care in an environment defined by poor overall achievement in outcomes and cost. These policy efforts have been a combination of structural shifts in administering the program coupled with coverage expansions, capacity building enabled by the Affordable Care Act, an increased reliance on privatization through managed care and a greater political focus on the program itself. As a result, Ohio has implemented a number of value-based reforms, leveraged federal dollars to update the basic eligibility and claims infrastructure which supports the program, and faced a number of efforts by the General Assembly to increase its influence on program design.

Medicaid has cemented its place as one of the most consequential policy endeavors of the state

The next governor, whomever that will be, will face a number of challenges affecting the delivery system inside and outside of Medicaid. While the current administration made strides in increasing access and redesigning the benefit to align with value, the next executive will have to determine which programs should be continued, which should not, and how best to execute a new vision within a politicized legislative environment. Expansion is, rightly so, at the forefront of this conversation, though it is not the only part of the cost-containment puzzle.

Today, Medicaid is responsible for making Ohio’s uninsured rate the lowest it’s been in the state’s history

That’s why, as a part of the Center for Community Solutions’ 18 questions for the 2018 election, we have 3 questions for the next administration:

• How will your administration continue Medicaid’s transition to value-based care?
• What will be your approach in working with the legislature on Medicaid policy?
• What do you believe are the best ways to control costs in the Medicaid program?