Ohio Medicaid enrollment has been declining for the past three years, since peaking in state fiscal year 2023, according to Ohio Department of Medicaid caseload reports.

Most of the decline is from people enrolled through the Medicaid expansion category, which covers working-age adults with low incomes, and the Covered Families and Children (CFC) group, which covers children in families with low incomes, as well as pregnant women, parents and related caregivers.

Total enrollment has now reached its lowest point in Ohio since 2020, near the start of the COVID-19 public health emergency (PHE). During COVID-19, enrollment increased due to provisions of the PHE, allowing people to remain continuously enrolled. When the PHE ended and normal eligibility processes resumed in April 2023, often referred to as “unwinding,” enrollment expectedly declined. However, despite the end of unwinding in March 2024, enrollment has dropped even further to 2.9 million Ohioans as of August 2026.

H.R. 1 is expected to cause significant changes to Ohio’s Medicaid program, with many of the Medicaid provisions in the law set to be implemented in 2027. Given these upcoming changes to Medicaid, measurement of H.R. 1-related impacts on Ohio’s Medicaid program will require careful attention to baseline enrollment levels at the time new provisions go into effect.

Note: This graphic appeared in the November 2026 edition of HPIO's Federal Health Policy Update