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Cleveland Right to Life v. Ohio, Court Strikes Down Effort to Limit Me... Skip to content

Court Strikes Down Effort to Limit Medicaid Expansion

Ohio’s Supreme Court denied several legislators’ request to invalidate Medicaid expansion, ruling that the Ohio Controlling Board acted within its statutory authority when it voted to approve the Ohio Department of Medicaid’s request for authority to accept federal funds to expand Medicaid eligibility.


Congress created Medicaid to give the most vulnerable populations access to health care services. The federal government provides substantial financial support if states elect to participate. However, a state must agree to provide specific levels of service to specified populations and its plan must be approved by the federal Department of Human Services (DHS). Every state currently participates in Medicaid.

In 2010, Congress enacted the Patient Protection and Affordable Healthcare Act (ACA). Among its provisions, the Act expands eligibility to individuals under the age of 65 with incomes below 133 percent of the federal poverty line. In 2012, the U.S. Supreme Court ruled that the federal government could not withhold all federal Medicaid funding from the states that decide not to expand eligibility to this new group. For states that elect to expand eligibility to this new category, the federal government pays 100 percent of the costs of covering the newly eligible group until 2016, at which time the federal contribution would begin to slowly decrease to 90 percent of the costs.

Ohio’s Governor John Kasich proposed changes to the state’s Medicaid program that would extend Medicaid coverage to the newly eligible group. However, the legislature replaced the Governor’s proposal with a provision that would not allow the state Medicaid program to cover the newly eligible group; but the governor then exercised his prerogative under Ohio’s constitution and vetoed that prohibition. The legislature did not vote to override his veto. Later, the Ohio Department of Medicaid requested that the Ohio Controlling Board increase appropriation authority for the state Medicaid fund — thereby allowing the state agency to accept federal funds for Medicaid eligibility expansion. The Ohio Controlling Board is a quasi-legislative body that is statutorily authorized to make certain decisions regarding appropriations, and it approved the request by a vote of 5 to 2.

A group of legislators and an anti-abortion organization asked Ohio’s top court to invalidate the Controlling Board’s vote and enjoin implementation of the plan, arguing that the Board exceeded its authority because it was statutorily bound not to take any action contrary to the intent of the legislature. They argued that the legislative intent was to prohibit Medicaid expansion, even though no such prohibition can be found in the enacted legislation.

AARP Foundation Litigation filed AARP’s friend-of-the-court brief, arguing that the Controlling Board’s actions were within its statutory powers because the legislative intent can only be expressed in the bill that was passed into law and that invalidating the Board’s vote would result in an unconstitutional abrogation of the Governor’s veto. AARP also provided important information to the court about the critical importance of Medicaid for vulnerable pre-Medicare eligible population as well as the impact on public health and taxpayer pocketbooks when the health needs of this population go unmet.

The Ohio Supreme Court ruled that the Controlling Board acted within its authority because its vote was consistent with the intent of the legislature as expressed in the act that is effective and in force, even if the act was modified by the governor’s veto. The court noted that the state constitution allows the legislature to override such a veto by repassage with a supermajority vote, and ruled that “[t]he legislature cannot circumvent this constitutional option by obtaining a writ from this court.” “Any other conclusion,” the Court held, “would create a constitutional crisis.”

What’s at Stake

Vulnerable low-income adults who are too young to qualify for Medicare suffer from chronic health conditions at higher rates than younger adults, but often cannot access health insurance because they do not have employer-based insurance, cannot afford private insurance, or do not qualify for publicly-funded insurance programs. As a result, their conditions go untreated, worsen, and later affect their lives and the public pocketbook when the conditions reach emergency status. Medicaid expansion under the ACA will allow more low-income adult Ohioans to live longer, healthier lives.

Case Status

State ex rel. Cleveland Right to Life v. State of Ohio was decided by the Ohio Supreme Court.