Regardless of who was elected governor, there were going to be lingering challenges related to Medicaid and health care to consider in the remainder of the 132nd General Assembly and into the next. How the next administration approaches those issues is up for debate.

At the Impact Ohio Post-Election Conference Thursday, the "Medicaid and Health in a Leadership Transition" breakout session focused on some of those lingering questions. On the panel were Sen. Randy Gardner (R-Bowling Green), member of the Senate Health, Human Services & Medicaid Committee; Tracy Plouck, executive in residence for population health at Ohio University and former director of the Ohio Department of Mental Health and Addiction Services; Rep. Mark Romanchuk (R-Mansfield), member of the Joint Medicaid Oversight Committee (JMOC); and Rep. Emilia Sykes (D-Akron), also a member of JMOC. The panel was moderated by Mike Toman of The Success Group.

Plouck said that most agencies and interested parties are focused on the upcoming budget season. Due to the expanding nature of fixed costs in Medicaid and health and human services, many of the submitted budget proposals from agencies may result in budget reductions, she explained. She also said that the agencies are also probably trying to assess the priorities of Gov.-elect Mike DeWine in their upcoming plans.

Gardner noted that he personally expected Democrat Richard Cordray to win the gubernatorial race, calling himself a "private pessimist." He said the DeWine victory will likely result in a smoother lame duck session.

He went down a list of bills that have passed at least one chamber of the Legislature that may see movement during the lame duck session: HB119 (Henne-McColley) regarding SNAP and Medicaid eligibility and benefits; HB131 (Gavarone-Reineke) regarding physical therapy practice; HB286 (LaTourette) regarding palliative care; HB535 (Gavarone) regarding opioid data reporting requirements; and SB259 (Hackett) regarding physician assistant practice. Legislation that has not yet passed a legislative body but might get some attention are step therapy reforms such as SB56 (Lehner-Tavares) and HB72 (Johnson-Antonio).

Of concern to Gardner are ongoing issues with behavioral health redesign and the transition of long-term services into managed care, though he said that he is not sure a legislative fix is necessary.

"I don't know that there's a legislative response necessary, but I can say that we've received, as members, quite a few phone calls with respect to payments and working through the Medicaid system. It's a much more detailed and complicated system now than it was. To say that it is not at least an area of concern to some members would not be fair," he said.

Romanchuk said he continues to focus on reducing caseloads in Medicaid and further developing "off-ramps" to successfully transition some beneficiaries out of the program to reduce costs. He recommended the administration first pause and examine all of the facts and information available before making any drastic changes to the Medicaid program. He also reiterated that the report of the Managed Long-Term Services and Supports (MLTSS) Study Committee, due by the end of the year, will likely not contain any direct recommendations. (See The Hannah Report, 10/25/18.)

Sykes said her priorities are to maintain health care coverage for her constituents, anticipating that the Democratic Caucus will be on the defensive during lame duck session. She warned against a proposed freeze to Medicaid expansion enrollees and cautioned her colleagues across the aisle of its impact on communities around the state, including the budgets of local hospitals that may see an influx of emergency room patients or unpaid claims.

"A Medicaid freeze would be horrific and immoral and quite frankly I hope that it's not something that we have to discuss beyond this panel, but I know that’s not true," she said.

Plouck said she hopes to see further innovative integration between behavioral health and physical health for those individuals involved in the criminal justice system in the future. She said that the state needs to look into those cases where individuals may recidivate because of untreated health conditions.

Toman noted that pre-existing conditions took front and center during this election cycle for both Democrats and Republicans and asked the panel if that might have any impact on the administration or Legislature. Both Gardner and Romanchuk said much of that remains the purview of the federal government and Congress, adding that not much will likely get done with Democrats now controlling the U.S. House of Representatives. Sykes said that she hopes those politicians who claimed or said they support protections for those with pre-existing conditions follow through on their words and treat that support seriously, not just as a political tool.

Plouck also mentioned that over $500 million of Temporary Assistance for Needy Families (TANF) funding has gone unallocated. She said there's a lot of complexity into how those dollars could be spent and said agile funding is needed to address problems in communities around the state. (See The Hannah Report, 10/2/18.) She praised the early work that DeWine's administration has done in putting children's issues front and center. Gardner said more needs to be done to address the challenges of multi-system youth, which could be a target of the surplus TANF funds.

Sykes said one of her priorities moving forward is to address Ohio's infant mortality rate, especially the widening gap between infant mortality rates of white and black babies. One key area that the state needs to pay more attention to is maternal support, identifying of the social determinants that affect a mother's health such as stress, violence and other factors in the community.

Touching on the opioid epidemic, Gardner said he's seen drug abuse response teams that are trained specifically to deal with overdose victims succeed in his area. Sykes said much is being done to prevent overdose deaths but few strategies are making significant improvements. She urged her colleagues to consider innovative solutions and harm reduction strategies like supervised use sites that may be politically difficult to pass but have shown positive results.

On a concluding note, Sykes reiterated her opposition to the ongoing effort to establish work requirements for Medicaid beneficiaries, citing the court decision in Kentucky that found such requirements did not contribute to the mission of the Medicaid program. Romanchuk and Gardner were supportive of the requirements, saying that the federal waiver to implement them is likely to be accepted soon.

"A thoughtful and compassionate incentive program to transition people off of Medicaid and into education and work is something we all ought to agree with," Gardner said.