How Kasich Could Expand Medicaid Without Legislative Approval

Sep 30, 2013

Beginning Tuesday, Ohioans can sign up on the new marketplace for health insurance called exchanges. But thousands of low income Ohioans would be eligible for Medicaid coverage if the state were to expand the program.

And they're still waiting to learn their options because the state legislature has not expanded Medicaid, despite the fact that Governor Kasich wants that to happen. As Ohio Public Radio’s Jo Ingles reports, there are still some options that could be pursued if the Governor decides to do it.

It’s not every day that Republican Governor John Kasich and Democrats agree on issues but when it comes to the issue of expanding Medicaid to cover 275 thousand low income Ohioans, they agree. They do not agree on how that should be done.  The Republican dominated legislature has not passed Medicaid expansion outright.  Lawmakers want to reform the program instead but there isn’t a plan in place right now to do that either.  Democrats, like House Representative Denise Driehaus have been urging Governor Kasich to use what’s known as a discharge petition to force lawmakers to vote on the issue now and that hasn’t happened either.  She says constituents in her district are frustrated that Medicaid expansion hasn’t happened.

Driehaus – People simply don’t understand and to be honest with you, I don’t have a very good explanation as to why we are not getting this done and I told them I share their frustration.

Back in July, Governor Kasich said he still wants Medicaid expansion but was clear he doesn’t think it’s appropriate to use heavy handed tactics to get it.

Kasich – If I put people in a corner, I am unlikely to get what I want to help people who need help.  Now if I just be persistent and pleasant and working on this…, all options are on the table.

Republican House Representative Barbara Sears explains one option. She, like Governor Kasich, wants Medicaid expansion.  And she says one option to get it would be for Kasich to sign an executive order to expand Medicaid then take it to a legislative panel for approval.

Sears – The legislature has given him that tool in previous budgets.  So we gave him the opportunity to to do this by executive order so he does have the opportunity to do that.  He does need to come back to the controlling board to fund but he wouldn’t even need to do that right away.

But so far, Kasich hasn’t given any public indication that he will issue an executive order to expand Medicaid.  Neil Clark, who oversaw work on budgets for the Senate republican Caucus in the 80’s, says it wouldn’t be unprecedented for a Governor to use an executive order for something like this.

Clark – Those have been done numerous times through every Governor’s administration.  Those executive orders, of course, terminate at the end of his term so in the short term, an executive order would be a temporary solution to start Medicaid expansion in Ohio.

In fact, Clark says there’s a way that Ohio could get the money for Medicaid expansion even if the Governor doesn’t issue an executive order. Clark says the Medicaid department could ask the controlling board for the federal money offered through Medicaid expansion.

Clark - But the controlling board can take the 90% if it were in the form of a grant, they could take it in the form if there were suitable funds available to make that ten percent match that didn’t increase the GRF appropriation or expenditure, you know what I’m saying there that it didn’t increase the expenditure then I think they could easily take the money in the controlling board.

Clark says that means if the agency could come up with the ten percent from within its own funds, the federal money could be put into the Medicaid program.  At any rate, any action like this would require a seven day notice to the controlling board which hasn’t been given yet.  Meanwhile, legislative leaders who’ve been working on Medicaid expansion, including Representative Sears, say they will come out with a bill soon. But on October 1st when many Ohioans are starting to explore their options, low income Ohioans who would qualify for Medicaid expansion still won’t know theirs