Why Medicaid Matters

The growth of Medicaid spending is strapping Ohio’s budget and putting a strain on our economic recovery. Medicaid is the public insurance program for people with low incomes and people with disabilities. There are over 1 million children and hundreds of thousands more parents, senior citizens, and people with disabilities enrolled in the Ohio Medicaid program. Medicaid is different from Medicare. Medicare is the public insurance program for nearly all senior citizens and is not based on income but age.

Medicaid is a partnership between the federal government and the states which began under Lyndon Johnson in the mid 1960s. The federal government pays a portion of the cost and the states pick up the difference – usually on about a 60/40 or 70/30 percent split. For example: if a Medicaid-covered child needs to go to the doctor and the charge is $100, the federal government pays around $70 and the state pays around $30. Most of the Medicaid spending in Ohio and other states is for long-term care for the elderly (e.g. nursing homes).

States are required to cover certain medical expenses in order to receive the federal portion their money. Hospital stays, physician costs, home health, nursing home care, and medical/surgical care for vision and dental are all required services. States have the OPTION of covering other services and Ohio has a very rich menu of options including prescription drugs, speech therapy, regular dental care, hospice, and others.

Mental health and substance abuse services are included as options under the Ohio plan. In the 1980s, advocates for mental health and alcohol/drug treatment services were successful in getting these vital services included in the options menu. Being included in the options however, was not free to local communities.

There was a catch: the partnership for behavioral health services is not between the federal and state governments but between the federal and LOCAL governments. If a Medicaid covered person receives an hour of counseling at $100, the federal government pays $70 and the local Alcohol, Drug Addiction and Mental Health Services Board - that's us -pays the match of $30. The Board can use state funds and local levy dollars to pay their share.

And it worked. Until now.

In the past, our Board has funded many wonderful (but optional) non-Medicaid services. Support services such as helping our adults with severe mental illness prepare for and find meaningful work, providing a safe and productive place to socialize and get support such as Changing Seasons, or helping working but uninsured families pay for their counseling services through a sliding fee scale, are what has made the We Care system strong. All of these things are now gone or threatened due to severe budget cuts and our requirement to pay Medicaid match.

Unlike most insurance plans, there is no limit to Medicaid. If someone with a Medicaid card wants a particular service, then they get it. No limits, no real proof that the service is necessary. Without checks and balances, the sky is the limit. That’s great if service providers are principled in their provision of service. It is a runaway train if service providers overuse the system. In either scenario, we have to pay our part of the bill – no questions asked.

The We Care system is committed to providing mental health and alcohol/drug services to as many people as we can possibly afford. We would never want children or anyone to not get the counseling and support services they need to be happy and healthy. We just want to make sure we use YOUR resources wisely. In the case of Medicaid, it is YOUR tax dollars that are paying the bill. We want to partner with you, the tax payer, to make sure that when YOUR family needs help, we can be there!