Sunday, April 6, 2003

Census shift costs Ohio $92M in Medicaid

By Carl Weiser
Enquirer Washington Bureau

WASHINGTON - Maybe Ohio should skip the next U.S. census. Besides costing the state a seat in Congress, the 2000 census results have cost Ohio $92 million in Medicaid money, a new report from Congress' General Accounting Office shows. Ohio lost more Medicaid money than any other state except Michigan.

  When the federal government plugged in the new 2000 census numbers, it slightly reduced how much money would flow to Ohio, Kentucky and Indiana for four major federal programs:
• Medicaid: $92.2 million loss to Ohio; $14.9 million loss to Kentucky; $13.4 million loss to Indiana.
• Social Services block grant: $1.2 million, Ohio; $215,000, Kentucky; $205,000, Indiana.
• Foster care: $2.6 million, Ohio; $169,000, Kentucky; $166,000, Indiana.
• Adoption assistance: $748,000, Ohio; $37,000, Kentucky; $98,000, Indiana.
• Totals: $96.6 million, Ohio; $15.3 million, Kentucky; $13.9 million, Indiana.
- Gannett News Service
Jon Allen, spokesman for the state department that handles Medicaid, dismissed the cut as "hypothetical." The $92 million is what the state would have gotten only if Census 2000 never had been conducted. It didn't affect the state's budget calculations, he said.

Ohio can't do anything about the lost money, just as Kentucky or Indiana are helpless to retrieve the $14.9 million and $13.4 million, respectively, each of those states is losing in Medicaid money, according to the GAO report.

But while the numbers are hypothetical, the effect of the losses is real, advocates say. The adjustments in federal matching money come at a time when Ohio, Kentucky and Indiana already are cutting Medicaid services to cope with deep budget crises.

Gov. Bob Taft has proposed freezing physician payment rates, eliminating benefits like dental, vision, and mental health services and curtailing eligibility for some of the 1.5 million Ohioans on Medicaid in a typical month.

"The cuts in the states, particularly to our state, are just devastating," said Margaret Hulbert, the United Way of Greater Cincinnati's vice president of public policy.

The numbers matter

The change in Medicaid money is one example of how the once-a-decade census can affect Tristaters' lives.

For Ohio, the first hit from the 2000 census was the loss of one of its 19 House seats. Indiana's House delegation lost one, dropping from 10 to nine.

While every state's population grew from 1990 to 2000, Ohio's and Indiana's grew slower than other states. So some of the 435 seats in the House were shifted to faster-growing states like Arizona, Georgia and Texas.

With Medicaid, the changes are more subtle. Numbers used to allot Medicaid money are adjusted every year. The program uses estimates that start with the previous census's numbers then work in births, deaths and immigration.

Fiscal 2003, which began in October, is the first year the federal government has plugged in numbers from Census 2000 for Medicaid and a number of programs.

When the Census Bureau did its 2000 headcount, it found estimates had been low for every state. But the gap varied from state to state.

In some states the census found more people than estimates would have predicted. That's because the 2000 census was considered exceptionally accurate; it found millions of hard-to-find illegal immigrants. So states with high Hispanic populations like Arizona, Florida, Nevada and New Mexico ended up with the largest corrections.

After all the numbers are crunched, Medicaid ends up with a percentage match from the federal government. Poorer states, like West Virginia and Mississippi, get more than 75 cents of every Medicaid dollar paid for from Washington; wealthier states, like Connecticut and Delaware, get a 50-cent match - the minimum set by law.

The percentage changes every year for every state. The past five years in Ohio, it has ranged from 58.26 percent to 59.03 percent.

This year, the government pegged the match at 58.83 percent. That means that for every Medicaid dollar spent in Ohio, Washington contributes 58.83 cents. The state picks up 41.17 cents.

The 2003 match for Ohio was slightly higher than the one for 2002, so Ohio's match improved.

But if the 2000 census never had been conducted, the match would have been 60.05 percent, the GAO said. And that's what would have made the $92 million difference.

How Ohio lost

Ohio's gap between the headcount and estimate was small. States with a larger gap gained Medicaid money. Arizona netted an extra $43 million, Florida an extra $122 million.

Medicaid wasn't the only program affected. The GAO report released in March looked at other grant programs. It found that Ohio, Kentucky and Indiana also lost money for foster care, social services and adoption assistance.

"It's totally justified from a scientific and technical standpoint," said the University of Cincinnati's Al Tuchfarber, director of the Greater Cincinnati Survey and National Health Survey.

The older, less accurate estimates had been working to Ohio's advantage. The new more accurate data worked against Ohio, as well as Kentucky and Indiana, said Matt Kane, a policy analyst with the Northeast-Midwest Institute in Washington.

Unlike the loss of the census seat, Ohio's loss was not the result of a pie being divided differently. Rather, the federal match ended up smaller than what it would have been because Ohioans looked wealthier - relative to the national population - than they had seemed.

In the grand scheme of Medicaid funding, plugging 2000 numbers into the formula shifted around $380 million nationwide. That's less than 1 percent of the federal government's Medicaid spending.

Even the $92 million loss to Ohio is about 1 percent of the state's annual Medicaid spending.

The same is true for Kentucky, which already has trimmed Medicaid spending. It's looking to cut another $169 million, said Gil Lawson, spokesman for the state's Cabinet for Health Services.


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