JMOC: The Medicaid Group VIII Assessment Findings and Highlights on the Medicaid Portion of the Executive Budget

Director Barbara Sears cemented her first 56 days as Director of the Department of Medicaid by briefing the Joint Medicaid Oversight Committee (JMOC), a committee she once chaired, on the Ohio Medicaid Group VIII Assessment (Expansion) report and Medicaid highlights from the executive budget, House Bill 49.

The Medicaid Group VIII Assessment report highlights key findings from an examination on Group VIII, otherwise known as the Medicaid expansion population in Ohio. A large sample size was used to gather data to examine, from a wide variety of sources and through biometric screenings, medical records, Medicaid records, focus groups and stakeholder interviews.

Highlights from Director Sears’ testimony include:

  • 14.1 percent of adult Ohioans with family income at or below 138 percent of the federal poverty level (FPL) are uninsured.  That number has been more than cut in half since 2008, when 36.1 percent were uninsured.
  • 89 percent of enrollees had no insurance at the time of enrollment.
  • 34 percent of individuals reported using the emergency department less than before enrollment.  Director Sears explained this number has been verified by hospitals throughout the state who have seen a decline in emergency department visits by Group VIII enrollees.
  • 27 percent of Group VIII enrollees received a chronic disease diagnosis after enrolling in Medicaid.

More information on the Medicaid Group VIII Assessment can be found here, in a recent blog post by The Center for Community Solutions (CCS).

In addition, Director Sears presented key information on the Medicaid portion of the newly released executive budget, emphasizing that on March 8th the director will be giving a more in-depth version of her testimony before the House Finance Sub-Committee on Health and Human Services.

In her JMOC testimony, Director Sears focused on:

  • The success of managed care and the administration’s plan to make managed care available to individuals receiving long-term care services.
  • Additional revenue constraints in the coming budget.
  • The need to remove nursing home rates from the Ohio Revised Code.
  • The integration of mental health and addiction services into Medicaid.

Furthermore, the Director discussed the additional spending for individuals with disabilities, as the growth projections will rise with the inclusion of these individuals in the overall Medicaid growth rate. In the proposed executive budget, spending will rise past the JMOC target rate of (3.30 percent) to 6.38 percent by 2019. However, as the state has shown in its initial budget impact documents, excluding investments in developmental disabilities (DD) puts overall growth at 1.64 percent and -0.83 percent in fiscal years 2018 and 2019, respectively. The spending target rate is set by JMOC as an attempt to monitor and control the growth in spending of the state Medicaid program.  As the budget process continues to play out, we will begin to understand the repercussions of an increased spending rate over the JMOC target rate. During the questioning portion of the presentation, Representative Scott Ryan asked to see a similar break out of the DD rate compared to other areas of increased spending, such as prescription drugs.

Additional CCS material on the executive budget can be found here, in a recent blog post.