- Associated Press - Monday, June 1, 2015

COLUMBUS, Ohio (AP) - State senators are taking a hard look at a proposal in Republican Gov. John Kasich’s budget that would eliminate Medicaid health coverage for certain pregnant women and others who the administration says can get insurance through the federal marketplace.

Democrats and several Republican senators have questioned the plan, suggesting that rolling back coverage for some low-income, pregnant women conflicts with the state’s efforts to combat infant mortality.

Ohio has one of the worst infant death rates in the nation. Black babies die here at more than twice the rate of white infants.

Access to prenatal care is essential to helping expectant mothers deliver healthy babies, health care advocates say.

Currently, women who are pregnant or diagnosed with breast or cervical cancer can get Medicaid benefits in Ohio if their income is up to about $23,540 for an individual, or twice the federal poverty level. Kasich wants to trim eligibility for these populations by limiting it to residents making up to $16,243, or 138 percent of the poverty level.

Shifting the eligibility would mean an estimated 3,000 pregnant women would no longer qualify for Medicaid each year. They would need to seek subsidized health coverage through HealthCare.gov or purchase private insurance elsewhere.

The House left the proposal in the $71.5 billion, two-year state budget it passed in April.

The Senate is preparing revisions to the bill, which are expected next week.

Senate Democrats have offered amendments to maintain Medicaid eligibility levels for pregnant women and those with breast and cervical cancer. Republican Sen. Shannon Jones of Springboro also has submitted similar amendments.

Sen. Capri Cafaro, a Hubbard Democrat, called the proposed eligibility changes “irresponsible.”

“We cannot show we care about countering our state’s abysmal infant mortality rate while we cut access to Medicaid for pregnant women,” Cafaro said in testimony last week to the Senate Finance Committee.

The Kasich administration has said that the Medicaid eligibility levels for the two groups were set when the federal exchange did not exist and the only alternative to Medicaid was to be uninsured. Additionally, the state has since expanded Medicaid eligibility to all those making up to 138 percent of poverty. About 510,000 now have access to Medicaid coverage because of the extension, including about 4,000 women with breast or cervical cancer.

“What we’re trying to do is simplify the eligibility for the program - straight, across-the-board, 138 (percent),” Ohio Medicaid Director John McCarthy said during a Senate hearing in April.

No one receiving Medicaid services through the pregnancy and breast and cervical cancer programs would be kicked off, he said. But new people would not be added to the programs beginning in January.

Part of the concern from lawmakers is that uninsured women cannot get medical coverage on the federal exchange if they become pregnant outside the open enrollment period. They could once they give birth. But pregnancy isn’t one of the exceptions that allow consumers to sign up outside the normal enrollment window.

Those eligible for Medicaid can enroll anytime.

The Kasich administration has acknowledged the proposal could create a coverage gap for some pregnant women because of the rules with the exchange. Officials say resolving the issue is a priority, and they are willing to work with legislators to fix it.

“We agree that coverage through that prenatal period is very important,” said Greg Moody, director of the governor’s Office of Health Transformation.

Restoring eligibility for pregnant women to twice the poverty level would cost the state about $15 million over two years, he said.

The administration has not endorsed a specific solution.

Jones also has proposed restoring the eligibility for pregnant women while paring down some of their benefits. Her amendment would exclude nonpregnancy related vision, chiropractic and podiatry services for those above 138 percent of poverty.

“The potential for us to save money lies in having healthy women and healthy babies,” she said. “We ought to do what we can.”

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