Ohio is preparing a Section 1115 Medicaid demonstration waiver application that, if approved, would require most of the members enrolled in Ohio’s Healthy Ohio Program to pay premiums and copayments for their health care coverage, a rarity among State Medicaid programs.  The centerpiece of the Healthy Ohio Program, as currently proposed, is the Buckeye Account, which is modeled after a health savings account. 

The Buckeye Account was designed to actively engage members in managing their healthcare expenses while exposing individuals to the costs of their care.  Under the proposal, both the state and the member would contribute dollars to the Buckeye Account.  The state-contributed dollars would be used to fund the plan deductibles, whereas the member-contributed funds would be used to pay for the member’s required copayments and qualified medically necessary services.  All members, except for pregnant women and individuals without income, would be required to contribute upfront monthly contributions equal to 2 percent  of income but not to exceed $99 per year (or $8.25 per month) into the Buckeye Account. 

If a member does not pay the required monthly payment within 60 days of the due date, the member will be disenrolled from the Healthy Ohio Program and required to pay back the debt before being eligible to re-enroll.  Most members in the Healthy Ohio Program will be required to pay copayments for services, which will be deducted from the member’s contribution amounts in his or her Buckeye Account.  If a member does not have contribution amounts remaining in his or her Buckeye Account, the copayment would be waived.  The Buckeye Account will also be used by members to collect incentive dollars earned for completing specific healthy behaviors, such as completing a smoking cessation program. 

The Healthy Ohio Program targets all Medicaid-eligible individuals aged 18 and older who qualify for Medicaid under certain eligibility categories.  If the individual is eligible for Medicaid based on those certain categories, the individual is required to be enrolled in the Healthy Ohio Program, even if the individual also qualifies for additional home and community based waiver services. 

Ohio estimates that the Healthy Ohio Program will save Ohio and the Federal government nearly $1 billion over the proposed five-year demonstration project.

The proposed implementation date for the Healthy Ohio Program is January 1, 2018.  A detailed summary of the Healthy Ohio Program is available here. 

Reporter, Kristin Roshelli, Houston +1 (713) 751-3263, kroshelli@kslaw.com.