Vulnerable Ohioans Impacted by End of Medicaid "Spend Down"
Ohio is creating a special Medicaid Waiver Program for people with severe and persistent mental illness. (Lloyd Morgan/Flickr)
January 11, 2016
COLUMBUS, Ohio - Streamlined Medicaid eligibility will mean changes for some vulnerable Ohioans. Currently, people with severe and persistent mental illness who don't meet income guidelines for Medicaid can deduct medical expenses from their income in order to qualify.
This "spend-down" eligibility is ending and instead those who qualify for disability with the federal government will automatically qualify under Medicaid.
Jon Honeck, director of policy and advocacy with the Center for Community Solutions, explains that because there are about $5,000 people with severe and persistent mental illness above the income threshold who won't qualify, Ohio is creating a special Medicaid Waiver Program.
"It will provide them with some home and community-based services basically to keep them stable, keep them in the community, enable them to keep working if they're working, enable them to attend their therapy sessions and provide them with some peer support if that's what they need," says Honeck.
Others who do not qualify for Medicaid because of income need to switch their coverage to the Health Insurance Marketplace. State leaders say the hope is to keep those who need Medicaid on the program, while directing those with higher incomes to private insurance. The program begins July 1.
As the waiver rules are drafted, Honeck says there are concerns the program may be restrictive.
"The devil in the details," he says. "But how tightly are the criteria being drawn around what types of mental illness, what types of hospitalizations a person may have had in the past."
The new waiver program will be operated by an independent entity contracted with the Ohio Department of Mental Health and Addiction Services. And Honeck asserts it's crucial the state be transparent as the program is implemented.
"This is a very vulnerable population and we want to care for them properly in the community," he says. "We want to make sure that they are stable. We don't want their health, their mental health, to deteriorate."
And he notes that without adequate services, costs could shift to jails, hospitals and local mental-health boards where funding is not as generous and services more difficult to obtain.