HPIO study explores the effect of Ohio Medicaid expansion, projects impact of eliminating coverage

(COLUMBUS, Ohio) – The Health Policy Institute of Ohio has completed a comprehensive, data-driven study to describe how the expansion of Medicaid in Ohio in 2014 impacted coverage, access and affordability and to estimate the future impacts of discontinuing coverage.
 
HPIO’s 2025 Ohio Medicaid Expansion Study is a valuable resource for reporting on the issue of Medicaid coverage and access to healthcare in Ohio. It includes a series of five reports looking at various facets of the issue:

► Access to mental health and substance use disorder treatment
This analysis found that, in 2024, more than $1 billion in federal funds paid for services for Ohioans such as outpatient counseling, psychiatric medical services and residential drug treatment programs.

► Parents, caregivers and their children
This report found that, as parents enrolled in Medicaid expansion, their eligible children were also enrolled in other Medicaid groups. This led to a drop in the percentage of Ohio children who were uninsured, from 7.5% in 2013 to 6.5% in 2023; lower than child uninsurance in non-expansion states (8.1%).

► The state budget
The brief concluded that discontinuing expansion would save substantially less than the state share amount, it would reduce federal funds coming to Ohio by over $42 billion over five years and would leave an estimated 435,000 additional Ohioans without coverage.

► Health insurance coverage and cost
This paper found that Medicaid expansion cut Ohio’s uninsured rate in half from 2012 to 2023. If expansion was eliminated, the uninsured rate could increase by 80% in 2026. Certain groups of Ohioans, including Ohioans with a high school education or less, would be more likely to become uninsured.

► Jobs and the economy
HPIO commissioned Regional Economic Models, Inc. to analyze the state and regional economic and fiscal impacts of reversing Medicaid expansion in Ohio. The report found that if Medicaid expansion is eliminated, Ohio’s economy (i.e., the state’s gross domestic product) would decrease by an average of $7.2 billion annually. It would slow job growth by more than 50,000 in Ohio, Ohioans would see an aggregate decline in personal income growth of $4.7 billion in an average year and the growth in state general fund tax revenue would fall by an annual average of $220.6 million.

The federal and state policy environment related to Medicaid expansion has continually changed during the state and federal budget processes. While universal reductions in the federal match for the Medicaid expansion population were not included in the bill passed by the U.S. House of Representatives on May 22, 2025, other proposed changes could impact Medicaid expansion in Ohio. These include proposed changes to work requirements, the frequency of eligibility checks and requirements to impose co-pays on services for adults under 65. KFF has more information on proposed federal changes to health insurance policy and potential impacts on Ohio.

At the same time, there are proposals from the 136th Ohio General Assembly to incentivize Ohioans enrolled in Medicaid expansion into Marketplace coverage. Additionally, the Ohio Senate’s version of the main operating budget bill for FY 2026-2027 maintains a provision that would automatically discontinue Medicaid expansion if the federal match rate dropped below the current 90% amount.

HPIO’s recently released 2025 Ohio Medicaid Basics and Policy Considerations: The Future of Group VIII (expansion) Medicaid Coverage in Ohio brief contain more general information on the Medicaid program overall and considerations about Medicaid expansion coverage as policymakers consider the program's future.