Gongwer: Senate President says Medicaid expansion off the table for budget, but leaves door open for ‘reform'

Senate President Keith Faber announced Wednesday that the Senate will not pursue an expansion of Medicaid as proposed by Gov. John Kasich for the biennial budget.

While not unexpected given the House GOP's firm stance against the proposal, the Celina Republican's announcement adds a note of finality to the budget debate even as the Senate is just gearing up its deliberations on the $61.5 billion, two-year spending package (HB 59).

The chamber leader, however, kept the door open a crack to add more Ohio citizens to the Medicaid rolls on the condition that there would be cost-savings involved with any program restructuring.

Instead of "expansion," Sen. Faber said, the chamber would work with the House majority to explore "reforms" to the entitlement that could entail covering more people under Medicaid but must also involve long-term savings to the state. Such a move would have to occur in legislation separate from the budget, he said.

Mr. Kasich's plan would have extended coverage to people up to 138% of the federal poverty level and was expected to draw down some $13 billion in federal funds over seven years to cover a vast majority of the costs of adding an estimated 275,000 people to the Medicaid rolls.

The proposal has been pushed aggressively by hospitals, business groups and government program advocates, but also fervently opposed by conservative groups and many Republican lawmakers who ran for election with a plank of opposing "Obamacare," or the Affordable Care Act, under which the expansion option was enacted.

Sen. Faber made his announcement at a Statehouse news conference while flanked by key lawmakers who will be shepherding the budget process, which is expected to see the Senate produce its version of the measure in early June.

"The House has indicated they simply don't have the votes to get Medicaid expansion done in the budget," Sen. Faber said. "Therefore, I do not believe Medicaid expansion is on the table as it relates to this legislation, in the budget."

"That's not to say we're ending the debate on Medicaid reform," he added. Sen. Dave Burke (R-Marysville) will convene a working group to explore options and the state will continue to seek guidance and flexibility on the program from the federal government.

"Our members want to review and work on Medicaid reform," Sen. Faber said. "We believe that there is a path to Medicaid reform that covers people who need it in the short term, while reducing costs in the long term."

"Our focus is clear. Any Medicaid proposal must include systemic Medicaid reform and flexibility from the federal government that allows us to have a system that works for Ohio. Preferably, this is a reform that allows us to provide more services to more individuals for less money."

Sen. Faber left open the possibility of enacting Medicaid revisions, noting the ACA deadline for the related changes was Jan. 1.

The Kasich administration remains hopeful that the separate bill can move along the same track, schedule-wise, as the budget. Faber spokesman John McClelland said after the news conference that remains a possibility, as long as members are comfortable with the guidance and input received from the federal government over the next few weeks.

"The House has also indicated they plan to explore reform in a separate, stand-alone bill," Sen. Faber said. "We are willing to work with the House as our partners with the governor."

Sen. Faber said his members "simply want more information" on the issue.

"They want to know the consequences, both short and long term, of making a commitment with the federal government," including ongoing liabilities, he said.

"I don't think Medicaid expansion is possible in the current budget. I do believe Medicaid reform is possible through the process that the House, the administration and now the Senate are going to engage in," the lawmaker continued.

"What that reform will be will depends in large part on the flexibility the federal government agrees to give us, and the initiatives and ingenuity that our members and the administration and (Office of Health Transformation Director Greg) Moody can come up with. That may include adding more people to the Medicaid system, but it has to include flexibility to reform and frankly transform a system that works better for Ohio."

Sen. Burke said "reform" task force discussions would ensue with the following goals:

•Establishment of firm annual per member, per month spending targets.

•Establishment of performance measures and targets that focus more on outcomes not outputs.

•Increased consumer involvement in the delivery of Medicaid services.

•Removal of costly legislative mandates that prohibit innovation and flexibility.

•Streamlined