Medicaid eligibility is changing and Ohio community health centers will take a hit. 

Medicaid eligibility is being re-determined in Ohio for the first time in three years.

A federal mandate allowed Ohioans to stay enrolled in Medicaid insurance, even if their eligibility had changed, during the COVID-19 pandemic. Now the federal public health emergency has ended and April marks the end of that protection. More than 200,000 Ohioans are expected to be deemed ineligible and lose their coverage in the next year.

The decline in Medicaid enrollment could mean big losses for community health centers, who largely serve low-income patients.

Teresa Rios-Bishop, membership director of the Ohio Community Health Center Association, said the impact for centers will be significant. She said many communities are bracing for how this could change their care.

“It certainly has a chilling effect for the patients and the health centers themselves,” she said.

Nationally, total health center revenue is expected to decrease between four and seven percent, according to George Washington University. That’s estimated to decrease capacity by more than one million patients.

Both patients and centers will feel the impact

More than 200,000 Ohioans are expected to be deemed ineligible in the redetermination process, according to reporting from the Statehouse News Bureau. That’s around 6% of the state’s Medicaid recipients.

Some recipients will lose coverage because of simple paperwork mistakes – like outdated contact information. That’s according to Lisa Jackson, the vice president of marketing at HealthSource of Ohio, a community health center with locations across southwest Ohio.

“We're really concerned because these patients will show up at our health centers, not realizing that they have lost coverage, and they would have to be converted to a self-pay status,” Jackson said.

As these patients lose their coverage, the community health centers will also hurt. Jackson said if 10% of their patients are unenrolled, as HeathSource of Ohio estimates, then the center will see a $1.4 million drop in revenue.

Medicaid is the largest source of revenue for Ohio community health centers, according to the Kaiser Family Foundation. More than a third of it is dependent upon the public healthcare program’s reimbursements.

Rios-Bishop said no Ohio community health centers have announced any plans to cut back on services. But, she said they’re still worried about residents who may fall off the so-called benefits cliff.

“Maybe they can't afford their employer-sponsored coverage, it's just too much out of their paycheck,” she said.

Getting re-enrolled

The focus of HealthSource of Ohio is getting community members who are still eligible re-enrolled, Jackson said.

The outreach looks different in urban and rural communities. Jackson said community centers in small towns have been working for years to gain the trust of their residents and dispel the myth that it’s wrong to accept Medicaid.

“We worked really, really hard in building the trust with those patients to say, ‘It's okay,’” Jackson said. “The unwinding kind of upheaves all of that,” she said.

The first letters notifying residents of their ineligibility were sent out by mail this month. The so-called “unwinding process” will last one year.

Rios-Bishop said the centers expect to begin to see the impact of the redeterminations at the start of May. That’s when many patients may go to their pharmacist to pick up medication and realize they are no longer covered.

“It'll be an unfortunate ‘a-ha moment’ for a lot of people,” she said.

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