Ohio is once again aiming to add work requirements for Medicaid.
The proposed work requirements could put up to 450,000 residents in Ohio at risk of losing health care coverage.
This estimate was calculated by The Center for Community Solutions. The state estimates fewer than 62,000 would lose coverage.
Medicaid currently provides health insurance for around 3 million low income Ohioans.
Gov. Mike DeWine supports work requirements. The Ohio General Assembly also included a measure in the latest state budget that requires the state to try to add work requirements.
"Today, there are over 160,000 jobs available through OhioMeansJobs.com waiting to be filled! A work requirement will help connect more people with great jobs like these — promoting self-sufficiency while also improving the wellbeing of our workforce," DeWine said in a statement in December.
States need approval from the federal government to make a change like work requirements, so the proposal will need approval from the Trump administration.
Digging into the data
Under the state's proposed change, to maintain Medicaid health coverage, Ohioans would have to work at least 80 hours a month. Ohioans could exempt from the waiver for various other reasons related to health and age, said Tara Britton, the director of public policy and advocacy at the Center for Community Solutions.The nonprofit think tank researches Medicaid, among other issues.
“If folks are 55 or over, if they are engaged in treatment for mental health or a substance use disorder, if they have a serious medical condition, if they are engaged in an education program,” she said.
The Center collected the latest, publicly available data on the employment and health coverage status of Ohioans to find that close to 450,000 Ohioans may be at risk of losing coverage.
That data also shows that close to 10% of the working-age population in Fayette, Clark and Montgomery counties will be at risk.
"The Ohio Department of Medicaid estimated that about 62,000 Ohioans would lose coverage or are likely to lose coverage under this proposal," said Emily Campbell, president and CEO of The Center for Community Solutions. "When the Center for Community Solutions looked at publicly available data on the number of people that are covered currently by Medicaid, the share of those people that are currently say that they're working or worked at least part time for at least part of the year, we came up with a much higher number."
According to Britton, Ohio has seen this type of work requirement before on similar proposals.
"Actually, one was fully executed, submitted under the prior Trump administration and when the Biden administration came into office, they pretty much put a stop to all of pending waivers that looked like those around the country," she said. "So knowing that there was a new administration coming into office in 2025, the legislature proposed to have the Department of Medicaid submit this under whoever the new administration was going to be in February of 2025 to just explore this option that states have to submit 1115 waivers."
Campbell said this work requirement is more likely to have an adverse effect on Ohioans by presenting them with what she calls a "catch 22" situation.
“Having untreated health issues is a barrier to work," she said. "But you have to have a job in order to have access to the care you need in order to address those health issues. And so in a lot of ways, it's backwards.”
Based on the Ohio Department of Medicaid's estimates, highly populated counties such as Cuyahoga County could see more than 8,000 residents between the ages 16 to 64 lose coverage.
"A number of those counties are the parts of the state that have been most impacted by the opioid epidemic and where we've seen high rates of overdose. And that's one of the things that I think is important to consider," she said. "In some ways this is turning back the clock to where we were a decade ago before Medicaid expansion in Ohio. When people who had mental health issues or were struggling with substance use disorder, if they didn't have children, it didn't matter how little money they made, they weren't they didn't get any access to Medicaid health coverage."
Public comment
There will be another round of opportunities for public comment as the state's proposal works its way through the system.
"This is the first step in a multi-step process before something like this would actually go into effect," she said. "Ohio Department of Medicaid has put out the draft waiver, has collected public comments. They will take those public comments and make any revisions that they they see fit and then it will be submitted to the federal government for consideration. That's likely to happen sometime in February."
Campbell said if the waiver is passed, it will be implemented sometime in the summer of 2026.
