On Tuesday, August 22, the Senate voted to override six of Governor Kasich’s Medicaid-related vetoes. In July, the House had overridden 11 of the governor’s vetoes, 10 of which dealt with Medicaid, meaning that the Senate can still act on four of those Medicaid-related provisions pushed forward by the House. Several of the veto overrides included provisions that would affect eligibility, rates, and the carve-in of certain Medicaid populations into managed care.
The following table documents the current status of a few of the Medicaid veto overrides:
The Senate confirmed several pieces of House override policy including the withholding of funds for the Medicaid expansion group through the Controlling Board, the requirement of Ohio Revised Code for optional coverage groups in Medicaid, and the halting of carve-in into managed care for the behavioral health population. You can read more about the implications of those choices in our State Budgeting Matters series. The effect of these decisions, in a broad sense, mean the Medicaid director and, by proxy, the governor, lose significant authority over how the Medicaid program is designed and implemented. Notably, as Managed Care models also represent a vastly different financing scheme from traditional fee-for-service, it will be interesting to see how the delay affects Medicaid expenditures, generally.
If one uses the figures associated with the delays highlighted by the Legislative Service Commission Comparison Document, for example, the delay of Behavioral Health represents a decrease of $122.6M in Fiscal Year (FY) 2018, but an increase of $129.6M in FY 2019. Given the direct fiscal effect of this policy choice, it remains unknown as to how these delays would affect the MCO tax figures budgeted by the administration and the General Assembly. Because the administration was assuming these carve-ins, a question remains if the delay might actually lead to a loss of revenue for counties dependent on the new tax arrangement with the federal government.
Beyond policy, it has been indicated that the House plans on coming back to pick up votes in early September. Given the comments from the Senate President regarding the freeze of enrollment in the expansion group, a provision he helped shepherd in the biennial budget process, it seems the votes may serve as a negotiation tactic with the House. As many elected officials in both chambers were supportive of revising the administration’s Managed Care Tax proposal (“MCO Tax”), and as many in the House were supportive of the Healthy Ohio waiver proposal, the Senate President may be leveraging parliamentarian rules to induce the House to bring up the freeze in exchange for items such as the MCO Tax or Healthy Ohio.
The first version of this blog incorrectly referred to Item 27 as the MLTSS delay. Item 27 dealt with Medicaid rates for Nursing Facilities.