Ohio eases access for Medicaid-eligible patients

COLUMBUS, Ohio - State officials are hoping to more easily grant uninsured pregnant women and children in Ohio access to health care services under Medicaid, if they are likely to qualify for the program that provides coverage to the poor and disabled.

A pilot program slated to start next week would let certain health care providers in Ohio presume the patient's eligible for Medicaid after an initial screening test. Children and expectant mothers would have to prove residency and provide other biographical details. The patients then could access the Medicaid-funded services immediately for 60 days while they apply for the program.

Determining whether a person is eligible for the Medicaid program can take as long as 45 days, state officials said. Case workers must evaluate applicants against more than 150 separate categories to make eligibility determinations.

The state wants to ease that enrollment time by allowing certain health care providers to presume Medicaid eligibility for children and pregnant women, the state's Medicaid director said Tuesday. That way, patients will get the medical services they need faster and could be on a healthier path sooner.

In general, potential beneficiaries do get served by some health care providers, but the delay in their Medicaid eligibility prevents them from getting prescriptions and any needed follow-up care, said Ohio Medicaid director John McCarthy.

"What we've done is change that," McCarthy told reporters at the news conference in Columbus.

The state has been doing a limited version of presumptive eligibility for children, but that could only be granted at county job and family services offices, limiting the effectiveness for individuals with immediate medical needs.

Under the pilot program, providers could perform an eligibility check and grant immediate medical assistance to both children and pregnant women where they receive their health care.

A test run for the presumptive eligibility program will start at Nationwide Children's Hospital in Columbus, MetroHealth System in Cleveland and the Community Action Committee of Pike County.

The state hopes to expand the pilot program statewide by January.

About 2.2 million Ohioans are enrolled in Medicaid. Roughly 1.2 million are children, and 30,000 are pregnant women, McCarthy said.

McCarthy said he's not sure how many expectant mothers and kids would come onto the program with the presumptive eligibility change.

He also acknowledged that a few number of people could be deemed eligible for the program in error, as a result of the initial screening process. And the state and federal governments would have to still pick up the tab for those folks, he said.

Still, state officials say that's a risk worth taking for healthier moms and babies.

"The earlier we can get those mothers prenatal care, and take care of those mothers, the better health outcomes we have," McCarthy said.

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