Graphic of the week: Ohio 1 of 8 states starting stricter Medicaid work requirements early

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A new federal rule on Medicaid work requirements released earlier this summer includes a provision allowing states a year of flexibility before fully implementing more stringent standards for medical frailty exemptions. However, as illustrated above, Ohio and at least seven other states have indicated that they will begin using the narrower definition of “medical frailty” immediately when work requirements go into effect on Jan. 1, 2027, according to reporting from Politico.
 
The 2025 reconciliation bill HR 1, sometimes referred to as the One Big Beautiful Bill Act, enacted work and community engagement requirements for Medicaid expansion enrollees. The 2014 expansion of Medicaid eligibility in Ohio contributed to a significant decrease in the state’s uninsured rate, particularly the percentage of working-age Ohio adults (ages 19 to 64) with lower incomes who are uninsured.
 
Yesterday, HPIO submitted public comment on the work requirement decision to the Ohio Department of Medicaid. The comment summarizes analysis and data that has been included in recent HPIO work, including its policy update on the implementation of Medicaid work requirements in Ohio.
 
HPIO’s public comment also summarizes new projections from healthcare consulting firm Manatt, which found that Ohio is expected to see its Medicaid enrollment drop by 305,000, or 10%, by 2028 because of the work requirements. Nearly all the people who lose their Medicaid coverage will become uninsured because they usually will not have access to other forms of health insurance. Analysis conducted earlier this year found that those at risk of losing coverage tend to have greater health challenges than those who are at less risk to meet the work requirements.
 
To learn more about Medicaid work requirements, other federal health policy changes and their impact on Ohio, see HPIO’s Federal Health Policy Update.