The best aspect of Obamacare is that it expands Medicaid into a convenient, comprehensive single-payer insurance system. Obamacare removes the onerous qualification interviews and byzantine enrollment hoops that have traditionally plagued would-be enrollees.

Not in Ohio, though. Here, the enrollment process is being complicated by bureaucratic mismanagement and the governor’s inability to lead his own party.

There are 5 ways to enroll in Medicaid in Ohio (federal website, federal phone, state website, state phone, and county Job and Family Services) and, depending on the route you take, you’ll get 5 completely different instructions. If you’re told by one source to go to another, well, God help you—it’s probably impossible for you to enroll right now.

The problem is that the state (the ultimate authority) is refusing to accept any data from the federal government; the state website isn’t entirely accurate; and county JFS isn’t being updated on the enrollment requirements in a timely manner. So you’ll hear from the feds that you’re enrolled, but you won’t be; you’ll be told by the state that you need to send paperwork to the county; and you’ll be told by the county that you need all of the paperwork required for food stamps and housing assistance.

(For the record, I understand that the best way to get coverage is to call the Ohio Consumer Medicaid Hotline at 800-324-8680 and explain that you’re only interested in enrolling in Medicaid.)

To understand why this is happening—and why it’s the governor’s fault—there are a few things that need to be made clear.

1. Medicaid enrollment requires less documentation than any other means-tested program. Since it saves taxpayer money to enroll somebody in Medicaid rather than the exchange, Medicaid enrollment requires only proof of income. Since the insurance exchanges interact with IRS records, most people don’t even need to supply that.

Other programs (SNAP, TANF, housing vouchers, etc) have lengthy questionnaires, requiring a wide range of documents. Traditionally, Ohio Benefit Bank has handled enrollment in all of these programs and required people to bring all of the documents—even those for programs for which they aren’t interested in applying.

Therefore, encouraging Medicaid applicants to apply for other means-tested programs is a significant barrier to entry.

2. Medicaid is entirely a state-administered program. While the Affordable Care Act establishes new Medicaid guidelines and funds the entirety of Medicaid expansion at the federal level, it allows states to keep administrative control of the program.

In Ohio, Lt. Gov. Mary Taylor (who is also the Director of our health care exchange) specifically barred HHS  from performing Medicaid enrollments in Ohio. Instead, Ohio will continue to perform all Medicaid enrollments—including those that are received through

The result is that Ohio is maintaining full regulatory authority, the same way that it maintains exclusive power to select plans  on the exchange. It’s technically a Federally-Facilitated Exchange, but the Lt. Gov. has more authority over it than does HHS.

3. Ohio is rejecting a federal offer to cover the people who enroll in Medicaid at One of the last remaining technical snafus of Obamacare enrollment is matching the federal Medicaid database with state Medicaid databases. While the blame for this falls largely on federal administrators, it bears mentioning that Ohio’s Medicaid database is 1 month old. The previous database, CRIS-E, was from 1978.

Since the data migration will likely take months, the federal government has offered to pay the states for everybody who enrolled in Medicaid through (even if those new enrollees were already qualified under pre-Obamacare guidelines). This is basically free money for the states—by and large, it’s the federal government picking up the full freight of new CHIP enrollees.

This process creates some headaches for bureaucrats, sure. But bureaucrats can treat those headaches—they have health coverage!

4. County departments of Job and Family Services aren’t being directed by the Ohio Department of Medicaid. Until very recently, Medicaid was housed under ODJFS, and Medicaid enrollment was handled primarily by county JFS. With Medicaid expansion, this arrangement no longer made sense.

Now Medicaid is its own department, administratively separate from ODJFS. However, there are no county Medicaid offices so Ohioans are being told to go in person to county JFS offices. Once there, it seems that JFS personnel are directed to enroll them in Ohio Benefit Bank and deny them Medicaid coverage until they do so.

This is hugely problematic because they aren’t being told to bring the documentation for JFS-administered programs! For people who aren’t looking for housing or food assistance, this means they have to take 2 days off to make 2 completely unnecessary trips.

The obvious workaround is to have county JFS employees stop forcing people into Ohio Benefit Bank. With the change in oversight, however, it’s unclear who in the Kasich administration will step up and fix the problem.

5. Most of this is happening because Kasich waited too long to expand Medicaid. These problems are all a matter of administrative miscommunication, and will sort themselves out in a few months. Had the Controlling Board decision to take the Medicaid expansion funding come a few months earlier, then the problems would already be resolved.

Alternatively, had Kasich been able to lead his own party’s legislators, they could have taken the Medicaid issue off the table entirely.

6. Ohio’s newspapers don’t seem to care that Medicaid enrollment isn’t working. Reporters are outraged with problems at but are more than happy to send people to… which has the same problems. They’re also seemingly unwilling to call anybody from HHS, but more than happy to report partisan statements from the Kasich administration.

There isn’t much that the federal government can do to fix Ohio’s Medicaid enrollment problems. As long as the media allows the Kasich administration to blame the federal government for its own administrative failings, it will remain way too difficult for Ohioans to enroll in Medicaid.