Patients presumed Medicaid-eligible get immediate aid under Obamacare

Nearly 4,000 Ohioans OK'd presumptively for coverage.
TNS Regional News
May 12, 2014


The stroke that temporarily robbed Andrew Starkey of the use of his left side hit at a vulnerable time for the Marietta man’s family.

Only a week into his new job as a heavy-equipment operator, he had not yet worked enough hours to qualify for the company’s health plan. His wife, Robin, had no coverage available through her part-time job as an aide in a doctor’s office.

But Starkey, 51, received good news during his six-day stay this month in OhioHealth Riverside Methodist Hospital, where he underwent an angioplasty and will have surgery on a blockage and blood clot in his carotid artery. He is eligible for the Affordable Care Act’s new “presumptive eligibility” initiative. Those who qualify get Medicaid benefits immediately instead of waiting weeks.

Starkey, for example, had his prescription filled at no cost to him after leaving Riverside.

“I couldn’t believe it. I figured what cash we did have was going to be gone,” he said. “Words can’t explain the relief.”

As of last Monday, 3,924 Ohioans had been approved presumptively for coverage, said Sam Rossi, spokesman for the Ohio Department of Medicaid.

Some Ohio hospitals have been able to presume pregnant women and children are eligible for Medicaid since January, and that option was expanded at the end of March to all people eligible under Ohio’s recent Medicaid expansion. The choice to give patients immediate access to Medicaid rests with individual hospitals, not states.

State Medicaid officials have no estimate of how many people might qualify for presumptive eligibility in the future or how much money has been paid out to hospitals and community health centers.

Ohio is the only state so far that also has allowed community health centers to presume certain patients are eligible for Medicaid, said Julie DiRossi-King of the Ohio Association of Community Health Centers. “It’s extremely, extremely valuable,” she said.

The immediate access to Medicaid gives enrollees access to prescriptions that might otherwise go unfilled, as well as timely follow-up care from specialists. That might prevent a patient’s condition from getting worse or possibly rule out a return trip to the hospital.

Many people are eligible for Medicaid but don’t enroll until they’re in a crisis, said Joel Potts, spokesman for the Ohio Job and Family Services Directors’ Association, which represents county agencies that sign people up for Medicaid. Presumed eligibility gives those people a new way to access that help quickly when they’re in a jam, he said.

Under federal rules, Rossi said, Ohio Medicaid cannot recoup money from hospitals in cases in which patients who were given immediate Medicaid access were ultimately found ineligible for the program.

However, Ohio hospitals are expected to make sure that 85 percent of the patients who they presume are eligible for Medicaid complete a full application and submit it by no later than the end of the month after they receive the status. (Someone found eligible on April 15, for example, would need to submit a completed application by the end of May.)

Of those who complete applications, the expectation is that 85 percent will be found eligible for Medicaid, Rossi said.

If patients presumed eligible don’t complete applications, their coverage will lapse. Patients can be presumed eligible only once per year.

“You can’t go to the hospital seven times during the course of the year and get presumptive eligibility each time,” Rossi said.

It’s too soon to say how much Medicaid money has been paid out to hospitals for patients who should not have qualified for presumptive enrollment, he said.

Ohio State University’s Wexner Medical Center expects compensation of about $400,000 from Ohio Medicaid for patients it presumed were eligible, said Debra Lowe, the administrative director of revenue cycle. Without presumptive eligibility, Wexner Medical Center might have received as little as half of that sum, she said.

Of the 54 applications that Ohio State patients have submitted so far, only three have been denied, Lowe said.

Nationwide Children’s Hospital said it has presumed 355 patients as eligible for Medicaid so far; the families of most of them are still completing applications or awaiting a decision from Medicaid on longer-term coverage. There were 14 approvals and no denials as of Wednesday.

OhioHealth said it has presumed 478 patients eligible for Medicaid, with long-term eligibility decisions pending for 462 of them. The rest have been approved.

To help ensure a high approval rate, the health system is being “very conservative” in presuming patients are eligible, said Margaret Schuler, executive director of revenue cycle.

Mount Carmel Health System is taking steps to participate, a spokeswoman said.

Starkey said he’s never relied on government assistance and had to swallow his pride after his stroke.

“I will be functional, and I will be productive to where I can support myself and my family,” he said. “I won’t settle for anything less.”


By Ben Sutherly - The Columbus Dispatch, Ohio (MCT)

©2014 The Columbus Dispatch (Columbus, Ohio)

Visit The Columbus Dispatch (Columbus, Ohio) at

Distributed by MCT Information Services


swiss family

we should all be covered for everything all of the time..just like everyone should be accepted as being married with the same dignity and rights as everyone else even if they are in a opposite or same sex marriage.. oh hey, can we talk about Valley Beach??


I would have no problem with them as long as conducted themselves according to our moral standards. Some do ,and others are so obnoxious, like Military Uniforms in a Gay Parade. I don't see any Heterosexuals Parades with men and women running around grabbing their balls and vagina !

all fact or all...

@ swiss..I agree with you totally. Glad to see this man get the help he needed,Had the AHCA not been in effect he would have probably have lost everything only being on the job a week. It will be good for all Americans when it gets up and running smoothly.

Dr. Information

Hey swiss. I believe that marriage is between a man and woman. I don't tell others what they should do but my belief is my belief. Why should I change what I want to believe because people say I should.

As for the ACA, they are picking and choosing the articles they want to write to make this thing sound good when its been nothing but a complete disaster. Online State sites are so messed up states have abandoned them after dumping hundreds of millions of dollars trying to get them up and running.

On the same note, how about the guy who was stuck with a $400K bill after having paid 4 months of premiums (ACA) and then being told he was not covered.

CBO still estimates that in ten years 40+ million people will still be uninsured.

The ACA has about 10% good and 90% bad.


Doc, you have said it all.


All men are created equal,

funny how you skim over that part unless it has to do with Cousin Sex then you are all for it.


" I believe that marriage is between a man and woman."

So how exactly did Adam and Eve populate the world without incest?

You believe in incest then correct?

Dr. Information

You haven't read the Bible. That's obvious.


Re: "Those who qualify get Medicaid benefits immediately instead of waiting weeks."

Good news for this couple.

Conversely, if you think healthcare services are expensive now, wait until they are all FREE.

Medicaid (single payer) for ALL!!!


oohhhh obamacare....... I live in a family of 5, our income is around about $30,000 a year, we are what you would call poor. My husband and I make too much for medicaid, but if we get a health plan from the "marketplace", it would cost us $500 a month, which we cannot afford. Looks like Obama didn't think about us.


Hey folks! Let me give you an idea of how the ACA is making out on our fellow people.
Bob Evans cut all employee hrs to 29 and took benefits away so they don't have to pay.
AVI Foods took all employees down to 29 hrs so they don't have to pay.
Norwalk City employees taken to 29 hrs so they don't have to pay.
Sunoco is contemplating cutting all employees to 29.5 hrs so they don't have to pay.
These are just a few. These are the people that live paycheck to paycheck and serve you and me on a daily basis. They are now quitting their jobs to sit at home on welfare because they make more money. They don't have to drive to pay for gas, pay a sitter, etc. the ACA is a crock of sh&t that hurt more than it helped.


Hey about trying to be an in depth paper and talk to the people that work for these companies and get their story on how it hurts them. Stop publishing how great this act is. Do an in depth story on that.