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CLEVELAND, Ohio – Northeast Ohio hospitals are bracing for a wave of negative impacts if state and federal lawmakers follow through with Medicaid cuts that would take health insurance away from hundreds of thousands of Ohioans. Patients could lose their health care while in the midst of cancer treatment. The newly uninsured may avoid getting care because they’re afraid of the bill.
When they finally do see a physician, these patients will be sicker. Hospitals – which already pay millions annually to make up the difference between the cost of health care and what Medicaid pays -- would take a financial hit because they would foot the cost of care for the newly uninsured. Some systems – especially safety-net and rural hospitals -- might have to cut services or reduce their workforce.
And in a painful ripple effect, communities where hospitals are a major employer may see their already precarious economies suffer. “Ultimately, wouldn’t it be cheaper in the long run to keep people covered and healthy and not have our economic growth and our economic stability implode?” said Charlotte Rudolph, executive director of UHCAN Ohio, an advocacy group supporting affordable health care for Ohioans. Possible changes to Medicaid, explained The roughly 770,000 Ohioans who joined Medicaid under the state’s 2013 expansion program are at risk of being kicked off under potential state and federal changes .
The expansion program serves those earning up to 138% of the federal poverty line. For a family of four, that translates to $44,000 per year. The federal government currently funds 90% of the costs, and the state pays 10%.
Gov. Mike DeWine and Ohio House lawmakers, in their proposed budgets this year, added a “trigger” provision , which would eliminate all of Ohio’s funding if the federal government makes even a small cut to its federal share. If both cuts come to pass, Ohio’s entire expansion population will be disenrolled from Medicaid, explained UHCAN Ohio’s Rudolph.
The state proposal still has to go through a process with the House and the Senate before the final version becomes law. While Congress hasn’t approved any cuts yet on its end, Republican lawmakers are considering how to slash $880 billion in spending over the next decade. Experts and Democratic lawmakers say that would be nearly impossible without touching Medicaid.
For most other Medicaid populations in Ohio, which include people who are low-income, pregnant women, infants, children, older adults and people with disabilities, the federal government covers slightly less than two-thirds of every dollar spent and the state covers the rest. In another move that could boot Ohioans from the rolls, Ohio has requested a waiver from the federal Centers for Medicare and Medicaid Services to institute a work requirement for Medicaid recipients. If it accepts Ohio’s request, Ohioans would need to be one of the following to qualify for Medicaid: at least 55-years old; employed; enrolled in school or occupational training for at least 20 hours per week; enrolled in an alcohol and drug addiction treatment program; or have intensive physical or mental health needs.
Some hospitals would take the largest hit At three Northeast Ohio hospitals, as many as 21% of patients are on Medicaid. That figure includes the expansion population and all other Medicaid recipients. All hospitals would be impacted by the cuts because they must pay for the cost of care that Medicaid doesn’t cover.
But safety-net hospitals, like MetroHealth System, are particularly vulnerable if cuts occur, because they treat a disproportionate share of the region’s lower-income individuals. MetroHealth is “very concerned” about the possible cuts, “because they would negatively impact the most at-risk members of our community who have the greatest need for regular access to health care,” a spokesperson said. More than 75% of its patients use government-sponsored insurance like Medicaid, are uninsured or are MetroHealth employees, the health system said.
“It is our distinct hope that policymakers can balance the need to address healthcare costs while also maintaining coverage for those who need it the most,” the spokesperson said. The cuts could also hit rural hospitals, like Ashtabula Regional Medical Center, the hardest, industry watchers say. Rural hospitals face challenges due to their often remote geographic location, small size, limited workforce and low patient volumes, according to the American Hospital Association.
Rural Americans are more likely to be uninsured, to have lower incomes, and be older and less healthy than city-dwellers, the American Hospital Association said. In 2023, Ashtabula Regional Medical Center’s patient load included 19.6% Medicaid recipients.
It is the largest employer in Ashtabula County, employing over 1,300 people. “Reduced reimbursement from the Ohio Medicaid program could lead to reduced access to care, reduction in the services offered, financial instability for healthcare institutions, and further economic instability in Ashtabula County as a whole,” said Ashtabula medical center CEO Leonard Stepp, Jr. Medicaid shortfall, percentage of patients shows impact There are two ways to examine the impact on hospitals: Medicaid shortfall and percentage of patient population on Medicaid.
Medicaid shortfall is the difference between Medicaid payments to hospitals and the actual cost of care. If patients lose Medicaid coverage, each hospital’s shortfall amount would grow significantly, and those climbing bills would likely force them to make cuts in other areas to make up the difference. The Clinic, MetroHealth, Summa Health and University Hospitals, in total, spent about $840.
1 million combined on Medicaid shortfall in 2023, according to hospital data. The leader in this category was the Clinic, which had a Medicaid shortfall of $648.1 million in 2023, the hospital system said.
At the Clinic, 13% of its patients used Medicaid in 2023. “Any reduction to the Medicaid program would threaten access to healthcare services for patients and result in additional financial strain on all health systems across Northeast Ohio,” said Cleveland Clinic chief financial officer Dennis Laraway. At Summa Health, the percentage of Medicaid patients stayed even at about 21% in 2023 and 2024.
Summa Health serves 60,000 patients a year through the Medicaid program. “Any state or federal changes to Medicaid eligibility and provider payments would create barriers to care for many people in our community and significantly impact our organization financially,” said Tracy Carter, system director, government relations and health policy for Summa. “Our hope is that the current Medicaid model is preserved and that all Medicaid beneficiaries can continue to access essential healthcare services,” Carter said.
At UH, 18.2% of its patients were Medicaid recipients in 2023. Fighting the cuts Hospitals and health advocates are rallying to prevent Medicaid cuts.
Tuesday, the new Ohio Medicaid Matters coalition of some of the state’s largest human services agencies, health advocacy associations and hospital systems announced it is working to combat the threat posed to Ohio’s economy and workforce by possible massive cuts to Ohio Medicaid. The coalition, which includes more than 35 organizations, is urging Ohio lawmakers and DeWine to maintain authority over Ohio Medicaid benefits as the federal government weighs cuts to the program, the group said in a news release. “Medicaid is a foundation for health and economic stability,” said Teresa Lampl, CEO of the Ohio Council of Behavioral Health & Family Services Providers, which is part of the coalition.
“Access to health care empowers Ohioans to work, contribute and fuel economic growth.” The state coalition is fighting for the same thing as a group of chief financial officers of health systems from across the country, who recently met with lawmakers in Washington, D.C.
, to push against proposed Medicaid cuts, according to media reports. While Rudolph said her organization will help newly-uninsured people find healthcare plans through the Affordable Care Act, she’s deeply concerned about the potential fallout. “The federal cut is going to cause a cataclysmic ripple effect in our state and many others,” she said.
Julie Washington covers healthcare for cleveland.com . Read previous stories at this link .
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