While the United States is responding to the COVID-19 pandemic, it may be helpful to understand how Ohio Medicaid can play a role in “flattening the curve” and ensuring the health care delivery system’s capacity isn’t overwhelmed. Medicaid is a state/federal partnership, meaning steps can vary depending on the level of government initiating a policy. Below we describe what tools are available to Medicaid and some considerations state and federal policymakers should take to mitigate risk.
Streamline eligibility process
Many individuals who rely on Medicaid need to have their qualification statuses redetermined annually. The state should ensure individuals in the program retain their eligibility without the need to go to a local county office to fill out an application. This would reduce exposure not only to the beneficiary, but to county caseworkers. Additionally, while there is an online portal, many urban and rural communities in Ohio do not have regular access to broadband internet, so it may be difficult to submit things, virtually, especially as demand increases.
The state could address potential capacity concerns within counties by extending the beneficiary hearing schedule, suspending in-person interviews, enabling self-declaration of income and eliminating penalties for county caseworkers who make mistakes in application processing
The state has a number of options available under its state plan authority, including the ability to simplify the enrollment and renewal process associated with eligibility, leveraging its ability to use presumptive eligibility during an emergency. In addition, the state could address potential capacity concerns within counties by extending the beneficiary hearing schedule, suspending in-person interviews, enabling self-declaration of income and eliminating penalties for county caseworkers who make mistakes in application processing.
Create flexibility for nontraditional settings and benefits
State programs can also scale up benefits and adjust cost-sharing requirements during emergencies. This means the state can rapidly add coverage for new vaccines, finance service provision in non-traditional settings like motels and provide additional services through telehealth.
Ohio may also be able to pursue waivers to address emergent needs. This can include 1115 waivers, but it can also include 1135 waivers which can be activated if the president declares an emergency through the Stafford Act. These 1135 waivers can enable states to increase eligibility thresholds, diminish preapproval requirements for providers and enable expanded benefits (such as an increase in the number of meals delivered to homes).
Congress should consider increasing federal match
Medicaid is a counter-cyclical program, meaning Medicaid spending typically increases when there is economic strain. COVID-19 is going to have a number of negative economic impacts on production, supply chain and workforce availability. As such, if only in the short term, Medicaid will play an increasingly larger role to address the needs of a workforce that may be grappling with these consequences and the delivery system responsible for providing care.
There are immediate actions Ohio should explore, and others they could advocate for, from the federal government.
By temporarily increasing the federal match, Congress would be able to provide an economic stimulus and ensure the delivery system’s capacity is adequate enough to meet increased demand. This doesn’t have to be a blanket approach either. The federal government could develop policy that changes the matching percentage on a state-by-state basis.
It remains to be seen what the State of Ohio has currently planned or developed in regards to leverage Medicaid to address its response to COVID-19. That said, there are immediate actions Ohio should explore, and others they could advocate for, from the federal government. In the end, flattening the curve will ensure resources are there to meet demand, but resources also require the same level of thoughtful policy planning -- much as demand requires thoughtful individual actions.
