Ohio gets $10.8 million for making children dependent on government Medicaid

By Maggie Thurber | For Ohio Watchdog

As a reward for making more children dependent on a government program, the federal government is giving Ohio $10.8 million.

The money technically is a “bonus,” and it’s coming to Ohio because the state enrolled 143,508 more kids in Medicaid than they set as a goal.

Maybe the May phone-a-thon was the reason.

It seems sort of perverse, doesn’t it? After all, it was only a few years ago that states were being encouraged to get participants off of welfare. Now they’re being encouraged to do just the opposite, albeit with a different program.

According to a spokesman for the Ohio Department of Medicaid, getting more kids onto Medicaid is actually a good thing.

“By connecting more children to coverage at an early age, we are working to ensure longer and healthier lives for our young people,” Sam Rossi said in an email to the Cleveland Plain Dealer.

But is that really the case? Do kids enrolled in Medicaid really live longer? Are they really healthier?

A 2012 Medicaid policy brief examined the utilization of well-child care in nine states. Well-child care provides preventive services mandated in Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. The study found that fee-for-service Medicaid children “had lower utilization than national averages for the commercially insured children” and that the rates were worse for older children.

A December 2012 U.S. Government Accountability Office report looking at mental health care for children found that Medicaid enrolled children may not receive appropriate treatment.

“Our analysis of national survey data indicates that concerns raised by providers, children’s advocates, and others about potentially inappropriate prescribing of psychotropic drugs for some children and a lack of needed mental health services for some children may be warranted. Antipsychotic medications are of particular concern in light of the very serious side effects they can have for children, the limited understanding of their long-term effects, and their high cost. Children in Medicaid and in foster care are prescribed these medications at higher rates than other children. Furthermore, most children in Medicaid and many children in foster care with potential mental health needs do not receive mental health services that could help them.”

Then there is the Oregon Health Insurance Experiment. In 2008, Oregon conducted a random lottery for enrollment in its Medicaid program. After one year, officials examined the outcomes and found:

• Medicaid increased the likelihood of being admitted to the hospital by 30 percent, driven by hospital admissions not originating in the emergency department.
• Medicaid increased the likelihood of using outpatient care by 35 percent, using prescription drugs by 15 percent, but did not seem to have an effect on use of emergency departments.

The enrollees were all low-income adults and while there were some positive outcomes, the findings raise valid questions about whether enrollment in Medicaid is the best option to improve care and treatment.

Why isn’t the goal to have more kids covered by private insurance? Even the Affordable Care Act seems to move more people to Medicaid than it does to the marketplace.

But if kids do better under commercial insurance, why isn’t the federal government rewarding states for getting kids out of government dependency?

Ohio Watchdog attempted to find the answer to that question, and how the state plans to use the $10.8 million bonus, but phone calls and emails to Rossi were not returned.

Maybe it’s a good thing this is the final year of bonuses under the Children’s Health Insurance Program Reauthorization Act of 2009.

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