Every month, Karen Curlis faces a choice: Pay all her bills or get all the medical care she needs.
Curlis, 50, of Akron earns about $1,200 per month from small jobs and disability benefits. Her income is too much to qualify for full assistance from the state-run Medicaid program but too little to afford the cost for counseling to stay in recovery from a chronic mental illness.
“It’s like tossing eggs up in the air and seeing what happens,” she said. “It’s really been a challenge.”
Starting in January, Curlis might not have to choose anymore.
Curlis is among the 275,000 low-income, uninsured Ohio residents — including 26,000 in Summit County — who are expected to qualify for Medicaid if the recently approved expansion of the public health insurance program goes forward as planned.
A little-known state legislative panel gave the go ahead this week for Gov. John Kasich’s administration to spend federal money to expand Medicaid eligibility beginning in 2014.
Barring a court ruling reversing the decision by the Controlling Board, the state is moving forward with boosting Medicaid eligibility for adults to 138 percent of the federal poverty standard, or $15,856 for an individual.
Currently, Ohio adults without children are ineligible for Medicaid, except for low-income disabled residents. And in some low-income families, children qualify for coverage but their parents don’t.
The state is updating its website, http://benefits.ohio.gov, to allow people to apply for Medicaid online under the expanded eligibility guidelines, said Sam Rossi, spokesman for the Ohio Department of Medicaid. Residents also may seek assistance from their county Jobs & Family Services office.
The computerized eligibility system will direct people who don’t qualify for Medicaid to the federal Health Insurance Marketplace, where they can purchase health insurance with possible federal subsidies to help pay for the premiums.
The majority of Americans are required under the Affordable Care Act to have health coverage starting Jan. 1 or pay a possible penalty when they file their 2014 taxes.
“We expect in the next few weeks we will provide more information on how folks can move forward in enrolling,” Rossi said. “We are moving forward for Jan. 1.”
Linda J. Wilson, 61, of Akron, is one of the thousands of area residents who could benefit.
Health coverage lost
Wilson lost her health coverage several years ago when her employer cut her hours.
She’s been relying on the OPEN M Free Medical Clinic in Akron for care. This summer, she found swollen lymph nodes under her arm that were subsequently diagnosed in August as lymphoma.
Even with help from the free clinic and charity care programs at area hospitals, Wilson estimates she owes between $20,000 and $30,000 in medical bills for her cancer treatments.
She said she’s grateful for the care she’s received but hopeful she’ll qualify for Medicaid.
“It’s the grace and mercy of God that keep me going,” she said.
Liz Flaker, nurse administrator for the OPEN M Free Medical Clinic, estimates half of the center’s nearly 800 patients could qualify for Medicaid or subsidies to help purchase health insurance under the Affordable Care Act.
The agency plans to use trained volunteers to help educate patients about their health insurance options, Flaker said.
Waiting list at clinic
As more patients get coverage, the largely volunteer staff will be able to help more people, she said. The clinic now has a waiting list of about 50 people.
“We’re hopeful that this can be a helpful thing for our patients,” she said. “However, I don’t think it’s going to be the answer for all of our patient population.”
The region’s sliding-scale, federally qualified health practice also is preparing to help its uninsured patients find coverage.
Dr. Kristine “Kris” Drummond, chief executive of AxessPointe Community Health Center, expects about 4,000 of the practice’s patients to qualify for Medicaid once the expansion moves forward in January.
“This is going to have a major impact on our patients,” she said. “For patients who have never been exposed to ongoing health insurance, the comfort and security of having that insurance will open new doors for them.”
Patients should get better access to a wide range of medical and dental services, allowing them to be healthier and more productive, she said. “I think it’s going to change people’s lives.”
Last year, the U.S. Supreme Court upheld the federal health-care reform law but ruled states had the right to opt out of expanding Medicaid.
The federal government will pay 100 percent of the cost for three years for Medicaid patients newly eligible through the expansion in states that opt to raise the income limit to 138 percent of poverty. Federal funding then phases down to 90 percent.
After Ohio lawmakers refused to expand Medicaid eligibility, Kasich’s administration sought approval from the Controlling Board to spend $562.7 million in federal money this budget year and nearly $2 billion next year on expansion.
Ohio would have lost out on its share of the federal tax dollars if it didn’t move forward with expansion, said Marty Hauser, chief government relations officer for Summa Health System.
“As Ohioans, we’re paying taxes to pay for this Medicaid expansion,” he said. “It’s getting our dollars back from the federal government that we’re paying.”
Pushing for expansion
The Akron-Canton Medicaid Expansion Coalition, a group of hospitals, social service agencies and patient advocates throughout Summit, Stark and surrounding counties, pushed the state to expand Medicaid eligibility by using federal money available through the Affordable Care Act, also known as Obamacare.
Without Medicaid expansion, hospitals say they would be forced to absorb millions of dollars in federal payment cuts without the benefit of uninsured patients getting coverage. Summa would lose $26 million from 2014 to 2022 without Medicaid expansion, said Tracy Carter, co-chair of the local coalition and director of government affairs and health policy for the Summa Foundation.
“For us, it’s something we had to fight for, to get the money to come back into our communities,” she said.
Cheryl Powell can be reached at 330-996-3902 or firstname.lastname@example.org. Follow Powell on Twitter at twitter.com/abjcherylpowell.