About 61,000 Ohioans could lose their health insurance coverage in 2026 if the U.S. Centers for Medicare and Medicaid (CMS) approves Ohio’s proposal for work requirements, according to estimates from the Ohio Department of Medicaid.
The other 700,000 Ohioans covered under the Medicaid expansion could lose their health insurance if expansion gets terminated altogether due to provisions in the proposed state and federal budgets.
For the expansion group as a whole, the loss could happen at any time if the federal government decides to reduce how much it spends on the expansion group and the state’s current proposal passes through the Ohio General Assembly. The state would have to terminate the Medicaid expansion in Ohio if federal funding falls under 90% for that program, according to the state’s budget proposal, House Bill 96.
“Someone could be standing in line at CVS, have health insurance one moment, and then not have it the next,” said Kathryn Poe, a researcher at Policy Matters Ohio, a nonprofit policy research institute.
The federal budget bill proposes at least $880 billion in cuts to Medicaid and the Affordable Care Act, according to the committee report for the budget resolution, House Concurrent Resolution 14. About 20 million Americans rely on the ACA, and more than 72 million people rely on Medicaid, the report says.
Nationally, Medicaid cost $880 billion to operate in 2023, according to the Associated Press.
In Ohio, Medicaid cost $38.9 billion in fiscal year 2024, including both state and federal funds, according to Ohio Medicaid’s budget variance reports. There are more than 3 million Ohioans receiving some type of benefit or coverage from Medicaid.
An effort to ‘restore the dignity of work’
Ohio tried to implement work requirements for the Medicaid expansion group prior to the COVID-19 pandemic after the state received approval from CMS during President Donald Trump’s first term in office. The subsequent Biden administration withdrew support in 2021.
“This decision was disappointing, shortsighted, and contrary to our statewide efforts to empower Ohioans to reach their full potential,” said DeWine, Ohio House Speaker Matt Huffman, and Ohio Senate Leader Rob McColley in a joint letter.
The joint letter, addressed to Robert F. Kennedy, Jr., secretary of the U.S. Department of Health and Human Services, went on to say the proposed requirements were about promoting economic stability and financial independence.
“This waiver will restore the dignity of work while at the same time improving health outcomes for Ohioans,” the state’s letter said.
CMS will review the state’s request to implement the work requirements for the Medicaid expansion group within a 30-day window before moving on to negotiations with Ohio Medicaid if the requirements are approved. The state is requesting a five-year approval to implement the work requirements starting Jan. 1, 2026, through Dec. 31, 2030.
“Reinstating our work requirement will promote self-sufficiency, it will give more people the purpose and pride that comes with a job, and it will improve the well-being of Ohio’s workforce,” DeWine said.
The Medicaid expansion group includes low-income adults up to 133% of the federal poverty level.
The work requirement could also be met if the person is in school, an occupational training program or a treatment center. People who are 55 or older, as well as people with significant physical or mental health needs, would be exempt.
Other states saw ‘disastrous results’
The waiver Ohio Medicaid is seeking falls under Section 1115 of the Social Security Act, which gives the secretary of Health and Human Services authority to approve experimental, pilot or demonstration projects that are found by the secretary to be likely to assist in promoting the objectives of the Medicaid program, according to CMS.
The work requirements being proposed have to be budget neutral, meaning they cannot raise costs for the federal government, which already pays for 90% of the costs for the Medicaid expansion group. For Ohio Medicaid as a whole, about 69% of its funding comes from the federal government, according to the Health Policy Institute of Ohio.
If implemented nationally, estimates show work requirements for certain Medicaid members between the ages of 19 and 55 could save up to $109 billion over 10 years, according to the Congressional Budget Office.
Those savings could come at the cost of people losing their health insurance, opponents of work requirements say.
“The states that have implemented them, like Arkansas and Georgia, have had disastrous results,” Poe said.
A substantial number of people lost coverage, Poe said.
“It was so bad in Arkansas that a federal judge had to stop the program after the first year,” Poe said.
Raised costs, lack of evidence in other states
The Georgia program raised costs to an average of $13,000 per enrollee due to added administrative work needed, Poe said, while Medicaid data shows the average cost per enrollee in Ohio is about $9,520.
A study published in Health Affairs done on Arkansas’s program showed no evidence that low-income adults had increased their employment or other community engagement activities either in the first year when the policy was still in effect or in the longer term, after the policy was blocked, according to the Harvard researchers.
The goal of the work requirements is to connect people who are part of the expansion population with open jobs in Ohio, the governor’s office said. There are currently more than 150,000 jobs on OhioMeansJobs.com with the majority with a salary over $50,000.
There is a strong connection between being employed and improved health, Ohio leaders say.
“We are dedicated to delivering high-quality health care to millions of Ohioans every day, empowering them to take control of their own health,” said Maureen Corcoran, director of the Ohio Department of Medicaid. “By encouraging them to seek employment, we not only enhance their quality of life, but also contribute to healthier communities and a thriving economy in Ohio.”
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