HPIO analysis: Medicaid expansion cuts could limit Ohioans’ access to mental health, addiction treat

(COLUMBUS, Ohio) – New analysis released Friday by the Health Policy Institute of Ohio found that Medicaid expansion brought in more than $1.6 billion in federal funds in 2024 to pay for behavioral health services such as outpatient counseling, psychiatric medical services and residential drug treatment programs.
 
Click here to view the new report
 
If Medicaid expansion is eliminated, the state would have to cover those costs or face significant reductions in treatment availability. Maintaining current state investments and replacing even 50% of the federal funds would cost Ohio more than $999 million annually.
 
“If expansion was discontinued, many Ohioans would lose access to treatment,” according to the brief. “Policy priorities such as improving supports for recovery and re-entry and suicide prevention could be curtailed.”
 
The findings are included in the first in a series of policy briefs in HPIO’s 2025 Ohio Medicaid Expansion Study. 
 
Ohio policymakers are considering discontinuing Medicaid expansion coverage if the federal government reduces the Federal Medical Assistance Percentage (FMAP) (i.e., federal match) for this group below the current 90% federal contribution. That decision would impact approximately 770,000 Ohioans. 
 
The new brief describes the role of Medicaid as a funder of mental health and substance use disorder services and highlights considerations for how working-age Ohioans with low incomes would access behavioral health care if expansion coverage were eliminated. The brief also includes results from a survey of leaders of local Alcohol, Drug, and Mental Health (ADAMH) boards from across the state, who described how the loss of Medicaid expansion could impact their local communities.
 
Click here for a spreadsheet with county-level data on Medicaid expansion and behavioral health services
 
Since Ohio expanded Medicaid eligibility in 2014, hundreds of thousands of residents with lower incomes – including people who are working, parents, grandparents, veterans and caregivers – have gained access to medically necessary health care. As of March 2025, nearly 770,000 Ohioans are covered through Medicaid expansion.
 
HPIO’s recently released Policy Considerations: The Future of Group VIII (expansion) Medicaid Coverage in Ohio brief contains more general information and considerations about Medicaid expansion coverage as policymakers consider the program's future.

 For any questions about the brief or HPIO’s 2025 Ohio Medicaid Expansion Study, please call or text Nick Wiselogel at 614.530.9918 or email nwiselogel@hpio.net. 

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