By Catherine Candisky

Gov. John Kasich's administration projects tens of thousands of poor Ohioans will lose Medicaid coverage while taxpayers save nearly $1 billion under a plan to charge new fees for the government health coverage and impose penalties on those who miss payments.

The proposal, subject to federal approval, would require those being treated for breast and cervical cancer, teens coming out of foster care and other working-age, nondisabled adults on Medicaid to make monthly payments into a health-savings account to help cover their expenses beginning Jan. 1, 2018.

Nearly 3 million Ohioans are enrolled in Medicaid, the government health insurance program for the poor and disabled. About half would be subject to the new requirements which must be approved by federal regulators. Medicaid officials project an average of 130,000 beneficiaries would lose coverage each year of the five-year pilot. The number is not cumulative over five years because numbers may be duplicative, they say.

The projections and plan details were included in a six-page summary released Tuesday night by the Ohio Department of Medicaid. A full draft of the state's request will be unveiled April 15, initiating a one-month public comment period which will include two public hearings, April 21 in Columbus and May 3 at a location to be announced. State Medicaid Director John McCarthy intends to submit the request to the federal Centers for Medicare and Medicaid Services in June.

Advocates for the poor say the plan will cause many to be lose Medicaid.

John Corlett, president and executive director of the Center for Community Solutions and former state Medicaid director, said he believes the state is underestimating the number of beneficiaries who will lose coverage.

"It would undo a lot of the progress of Medicaid expansion," he said.

More than 650,000 adults with annual incomes under 138 percent of the federal poverty level, or $16,394 a year, have signed up for benefits since Jan. 1, 2014, when Ohio expanded Medicaid through Obamacare.

State Medicaid spokesman Sam Rossi said feedback will be included in the request, but cautioned "we can't change the proposal because the language was prescriptive."

House Republicans added the provision directing the administration to seek the changes to the state budget last year. Under the plan, certain Medicaid beneficiaries would be required to make monthly contributions equal to 2 percent of their income but no more than $99 a year, to a health savings account. Those who fail to make the payments will lose coverage and can't re-enroll until the debt is repaid.

Money in the accounts could be used to pay new Medicaid co-pays, including $75 for inpatient services and $8 for non-emergency use of emergency rooms.

Pregnant women would be exempt from both fees.

The plan, according to the state's summary, is to promote beneficiaries' "engagement in health and personal responsibility," increase use of preventative services and encourage people "to seek employment and private market coverage." If a Medicaid recipient obtains private coverage, any funds in their health savings account would be available to cover costs incurred with their new coverage.

Corlett noted that many components of the plan have never been approved by the federal government. For instance, no other state drops people with incomes below 100 percent of poverty from coverage for failing to pay a premium or contributions to a health savings account.

Federal officials have approved premiums in Indiana, Oregon and Wisconsin, but none have guidelines as strict as those Ohio is proposing.

State officials project about 15 percent of Medicaid enrollees will lose benefits if the plan is enacted. They would either be disenrolled for failing to make payments or choose not to sign up to avoid the cost.

House Republicans rejected Kasich's proposal to charge premiums only to those with incomes over 100 percent of poverty.

Supporters have argued that as Medicaid expansion costs begin to shift to states next year, Ohio must try to lower costs and encourage beneficiaries to take responsibility for their health care. Under the plan, enrollees also would earn points equal to dollars in their health savings accounts for quitting smoking or lowering their blood pressure.

(c)2016 The Columbus Dispatch (Columbus, Ohio)