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The Associated Press May 20, 2010, 5:39PM ET

Ohio Medicaid chief says early expansion unlikely

A tight state budget will make an expansion of health care coverage for the poor and disabled unlikely in Ohio this year, an option given to states under President Barack Obama's health care overhaul, the state's Medicaid chief said Thursday.

Even with the help of partial federal funding, the state will not have enough money to expand Medicaid now, director Tracy Plouck said in an interview with The Associated Press.

Many financially struggling states share the same concerns, and it's unclear how many will use Medicaid to fill coverage gaps before 2014, when most of the health care provisions take effect.

So far, only Connecticut and the District of Columbia submitted such proposals to the federal government. Medicaid is a federal-state program for the needy, blind and disabled, and for low-income families with children.

About 1.3 million people lack health insurance in Ohio.

The state estimates that 900,000 will get coverage by 2019 under provisions of the new federal law, including 554,000 who are expected to enroll in Medicaid. The law also creates state-level insurance supermarkets called exchanges, intended to help small businesses and individuals who buy their own coverage to pool purchasing power.

States will be required to extend Medicaid eligibility in 2014, covering people with incomes up to 133 percent of the federal poverty level, or about $29,327 a year for a family of four. Also, childless adults will be covered for the first time.

The federal government will pick up 100 percent of the cost for three years. After that, federal support gradually declines through 2020.

Ohio must examine closely whether it will need more staff and computer upgrades to handle additional Medicaid claims, Plouck said. The state spends about $13 billion a year on Medicaid, already the state's largest government program, providing a broad range of health services to 2.2 million.

There's also a challenge in getting doctors, who limit the number of Medicaid patients they see, to accept newly eligible recipients, said Andy Hyman, who oversees health insurance research for the nonpartisan Robert Wood Johnson Foundation.

To give doctors a bigger incentive, the federal government will raise Medicaid payments for primary care in 2013 and 2014, but the increases are temporary.

Gov. Ted Strickland, a Democrat, has pushed to increase Medicaid spending in recent years as more Ohioans lose jobs amid the U.S. economic downturn, raising money through fees on hospitals and nursing facilities and by seeking additional federal matching funds.

The federal government pays about 74 percent of Ohio's Medicaid costs, up from 63 percent several years ago because of aid from Obama's economic stimulus package, Plouck said. That increased aid runs out at the end of 2010, and it's unclear if Congress will extend it.

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