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Following weeks of speculation, Governor John Kasich announced today that his administration has secured federal approval for a proposal to expand Medicaid coverage to adults earning up to 138 percent of the federal poverty level. The Affordable Care Act (ACA) had originally expanded eligibility to include coverage for this population; however, a ruling by the U.S. Supreme Court said that Congress could not coerce states into expanding Medicaid, leaving the decision up to individual states.

Governor Kasich had previously included the measure, which would provide coverage for roughly 275,000 Ohioans, in his budget proposal, but the language was removed during House budget deliberations. Legislators opposing the measure expressed distrust for the federal government, which will cover the full cost of expansion during the first three years and phase down to a 90 percent federal match thereafter.

Rather than continue to wait on action in the form of legislation, the Ohio Department of Medicaid will seek Controlling Board approval to increase appropriation authority by nearly $2.5 billion in federal funds through the end of state fiscal year 2015. The Controlling Board is a spending-control authority that must approve certain state expenditures and oversees other spending-related decisions. Membership is comprised of three legislators from each chamber—two Republicans and one Democrat—as well as the Controlling Board President, who is appointed by the governor. In order for the appropriation increase to receive approval, at least one Republican member must vote for the measure.

In announcing his decision, Governor Kasich cited prior reforms to the Medicaid program, integration of state-of-the-art IT systems and better coordinated care for Ohioans with multiple chronic conditions as reasons the system is well-suited to serve the expanding population. He said expanding coverage will help keep working Ohioans in jobs, put Ohio’s federal taxes to work and create a ladder up and out of public assistance for low-income residents. The request will be considered at the October 21, 2013 meeting.