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One Funder’s Role in Medicaid Expansion and Affordable Care Act Implementation

July 2016

Mitchell Balk, President, The Mt. Sinai Health Care Foundation

The Mt. Sinai Health Care Foundation, a 19-year-old conversion foundation, has elevated its health policy agenda to advocate for health reform and create a key role for health philanthropy in the implementation of the Affordable Care Act in Ohio.

From the beginning, health policy has been one of Mt. Sinai’s four strategic grantmaking areas because government was, and is now more than ever, the biggest player in everyone’s health care. It is the biggest payer, and, as such, what government does or does not do has an enormous effect upon populations that are the focus of the foundation’s grantmaking, namely children, seniors, and the urban poor.

It is a critical time for those foundations active in health policy. The implementation of federal health reform presents the greatest opportunity to provide access to health care for uninsured Americans since the creation of Medicare and Medicaid in the mid-1960s. The 2012 Supreme Court decision on health reform left it up to the states to opt in or opt out of certain provisions of the Affordable Care Act, the most significant of which was the expansion of Medicaid. In Ohio, Medicaid expansion to 138 percent of the federal poverty line was expected to provide access to care to more than 600,000 of Ohio’s 1.6 million uninsured (people with an income of less than $33,465 for a family of four).

In Ohio, the Kasich Administration undertook a thorough review of what Medicaid expansion could mean for uninsured Ohioans and the economic impact of the $20 to $30 billion influx from the federal government over the first ten years of the program. Compared to what Medicaid expansion could do to improve the health status of the people of Ohio by improving access to health care, Mt. Sinai’s health grantmaking, and all of Ohio philanthropy, is not even a rounding error.

Mt. Sinai could not remain silent. As an entity dedicated to improving population health, the foundation felt compelled to act. Like other grantmakers, when Mt. Sinai gives voice to something and demonstrates concern for a policy initiative, it speaks with a megaphone. Because we sat on the cusp of an enormous opportunity to make a decision in Ohio that would advance the foundation’s mission beyond any check the foundation could possibly write, Mt. Sinai made the decision to become involved in advocating for Ohio Medicaid expansion as provided by the federal health reform legislation.

Specifically, Mt. Sinai did the following:

  • Through a grant to Greater Cleveland Congregations, Mt. Sinai helped create a Medicaid expansion support organization known as the Northeast Ohio Medicaid Expansion Coalition (NEOMEC), a regional collaboration of grassroots organizations and leaders of the faith-based community, who, like Mt. Sinai, had no financial stake in expanding Medicaid, but sought to advance their missions by supporting health care access to hundreds of thousands of the uninsured.
  • Mt. Sinai President Mitchell Balk contacted the editorial board of The Plain Dealer and convened a meeting between the Board and NEOMEC leaders that resulted in an editorial supporting Ohio Medicaid expansion.
  • Mt. Sinai, together with The George Gund Foundation and Interact for Health, supported a study managed by the Health Policy Institute of Ohio to document all of the likely (and very beneficial) effects of accepting the federal government’s offer to expand Medicaid in Ohio. The study was front page news in The Cleveland Plain Dealer, Columbus Dispatch, and other newspapers.
  • In recognition of Mt. Sinai’s role, Governor Kasich attended the foundation’s June 2013 annual meeting where he was presented with the Mt. Sinai Heart of Ohio Award for calling for the expansion of Medicaid and not bowing to the political winds.

Following Ohio’s success in achieving Medicaid expansion, Mt. Sinai has continued to play a leadership role in coalescing outreach and enrollment efforts to ensure that uninsured Ohioans are taking advantage of new coverage options available to them through the Affordable Care Act. Mt. Sinai recognized an opportunity to use remaining funds from the GIH Ohio Health Funders Grantwriting Assistance Fund, for which it served as fiscal agent, to support a statewide consortium application to become a federal navigator, resulting in a seven-figure grant to the Ohio Association of Foodbanks.

As various assisters were being trained and implementation plans developed to enroll individuals in Marketplace coverage, Mt. Sinai encouraged the Philanthropy Ohio Health Initiative and Health Policy Institute of Ohio to convene a statewide network of navigators, certified application counselors, federally qualified health centers, insurance agents, advocacy organizations, Enroll America, and others to share best practices and create transparency and collaboration for enrollment efforts. Relative to enrollment efforts, Mt. Sinai acted quickly to fund United Way 2-1-1 of Greater Cleveland to serve as a connecting hub for Northeast Ohio residents seeking enrollment assistance during the initial open enrollment period, providing health information and program referrals to assist the community in understanding health coverage options.

Through the activities described above, Mt. Sinai Health Care Foundation has expanded the role of the philanthropic sector from traditional investor to consensus and coalition builder and, working alongside government, effective implementer of new and expanded government safety net and entitlement programs in order to fulfill the Mt. Sinai mission.