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OPPA applauds decision by CMS to deny Healthy Ohio Program 1115 Demonstration Waiver

The federal Centers for Medicare and Medicaid (CMS) denied the Healthy Ohio Program 1115 Demonstration Waiver, which was submitted to CMS in late June by the Ohio Department of Medicaid. The OPPA has been a strong advocate against the demonstration waiver as a result of concerns about access to care created by requiring low-income Ohioans to pay premiums and locking them out when they can't pay.  

"After reviewing Ohio's application to determine whether it meets these standards, CMS is unable to approve the state's request for a new section 1115 demonstration," CMS Acting Administrator Andrew Slavitt wrote to Ohio Medicaid Director John McCarthy. "We are concerned about the state's request to charge premiums, regardless of income, to the 600,000 individuals in Ohio’s new adult group, as well as hundreds of thousands of low-income parents, foster care youth, and beneficiaries with breast and cervical cancer. CMS is concerned that these premiums would undermine access to coverage and the affordability of care, and do not support the objectives of the Medicaid program. In addition, Ohio's application would exclude individuals from coverage indefinitely until they pay all arrears, a policy that we have not authorized in any state. We do not believe that this practice would support the objectives of the Medicaid program, because it could lead to a substantial population without access to affordable coverage. Our concerns are corroborated by the data you submitted with your application that estimates that these policies would lead to over 125,000 people losing coverage each year."

Ohio Medicaid is not giving up on the idea of Medicaid patients being required to pay some type of premium. In response to the rejection, the Office of Health Transformation (OHT) noted that Gov. John Kasich had previously proposed instituting Medicaid premiums for non-disabled adults who earn more than 100 percent of the federal poverty level. "In light of today's announcement, the administration will restart talks with the General Assembly about other options for ensuring greater personal responsibility, including the premium program as originally proposed," OHT said.


CMS letter of denial 

OPPA letter to CMS expressing concern

Waiver request by Ohio Medicaid

OPPA letter to Ohio Medicaid




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