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The federal spending package that was signed into law last week will lead to a $37 billion reduction in federal Medicaid funds in Ohio over the next decade, KFF analysis projects.

Using estimates from the Congressional Budget Office, which showed that the bill would cut Medicaid by $1 trillion between 2025 and 2034, KFF projects that Ohio could receive 14% less in federal dollars for Medicaid. Every state is expected to lose funding, as illustrated above, but Ohio will lose more than all but six states, according to the analysis.

An analysis of the health impacts of the federal legislation by the National Academy for State Health Policy found that "The impact on state budgets will be felt most significantly by the 40 states and Washington, D.C., that have expanded Medicaid, with between 10 and 21 percent reductions in federal spending … State leaders will need to make decisions on how to account for federal funding reductions, with limited options for new dollars to make up any gaps."

As celebrations for Pride Month conclude, national data shows that living in accepting communities can prevent harm for LGBTQ+ young people.

In Ohio, gay, lesbian and bisexual youth are nearly 3 times more likely to report a suicide attempt in the past 12 months, with one in five (20%) gay, lesbian and bisexual high school students reporting that they attempted suicide in 2023, according to data from the CDC’s Youth Risk Behavior Survey. However, national data from the Trevor Project shows that LGBTQ+ young people who reported living in very accepting communities attempted suicide at less than half the rate of those who live in very unaccepting communities, as illustrated above.

HPIO’s 2024 Health Value Dashboard includes an equity profile for LGBTQ+ Ohioans. The Dashboard details how homophobia and transphobia are primary drivers of poor outcomes experienced by LGBTQ+ Ohioans of all ages. Experiencing discrimination can cause toxic stress, leading to poor health outcomes over time. Thus, LGBTQ+ Ohioans often experience worse outcomes than heterosexual and/or cisgender Ohioans across measures of health and social well-being. Policies and practices that limit access to necessary health care and a lack of protections for Ohioans based on sexual orientation and gender identity contribute to worse health outcomes for LGBTQ+ people compared to their heterosexual and/or cisgender peers.

The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) released a statement last week announcing that specialized services for LGBTQ+ youth who call the 988 national suicide prevention hotline will no longer be in operation starting July 17.

There are evidence-informed strategies that Ohio leaders can adopt to improve health disparities for LGBTQ+ Ohioans. By collecting data about the experiences of the LGBTQ+ community, ensuring access to developmentally appropriate care, improving provider education and including sexual orientation and gender identity in anti-discrimination laws, Ohio can create more accepting communities and close gaps in health outcomes for LGBTQ+ Ohioans.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org 24/7 for free and confidential support. The Trevor Project operates a 24/7 suicide prevention hotline for the LGBTQ+ community at 1-866-488-7386 (or text START to 678-678) and the Trans Lifeline suicide hotline operates Monday through Friday from 1 p.m. to 9 p.m. at 1-877-565-8860.

As the Ohio General Assembly continues negotiations in conference committee, a provision remains in the state’s biennial budget plan that would eliminate Medicaid expansion if the federal government reduces the Federal Medical Assistance Percentage (FMAP) (i.e., federal match) for those enrolled in this group.

A conference committee vote on the budget is expected next week and Gov. DeWine will then have the opportunity to line-item veto provisions in the budget. The Governor is required to sign the bill into law by June 30.

Data and projects included in HPIO’s recently completed 2025 Ohio Medicaid Expansion Study show that eliminating Medicaid expansion would lead to a projected 80% increase in the number of Ohioans who are uninsured. Ending expansion would also mean that Ohio would lose more than $1 billion a year in federal funds that are used to pay for mental health and substance use treatment, among other negative economic outcomes for the state.

Even if the complete elimination of Medicaid expansion does not occur, other changes under consideration at the state and federal levels could impact coverage and funding for services.

HPIO’s 2025 Ohio Medicaid Expansion Study includes a series of five reports looking at various facets of the issue, including Access to mental health and substance use disorder treatment, parents, caregivers and their children, the state budget, health insurance coverage and cost and jobs and the economy.

HPIO’s 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.

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 includes a series of five reports looking at various facets of the issue, including Access to mental health and substance use disorder treatment, parents, caregivers and their children, the state budget, health insurance coverage and cost and jobs and the economy.

The brief on health insurance coverage and cost, which was released last week, 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, as illustrated above.

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.

New analysis commissioned by the Health Policy Institute of Ohio projects that if Medicaid expansion is eliminated, growth in Ohio’s economy (i.e., the state’s gross domestic product) would decrease by an average of $7.2 billion annually, as illustrated above.

The analysis, conducted by Regional Economic Models, Inc., is the fifth and final in a series of briefs that are part of HPIO’s 2025 Ohio Medicaid Expansion Study.

According to the analysis, eliminating expansion would also slow job growth by more than 50,000 in Ohio, compared to if Medicaid expansion remained intact over the next five years. About 45% (more than 28,000) of the potential job losses would be in the healthcare sector and 55% would be spread widely across the state economy, including more than 6,400 construction jobs, more than 2,500 jobs in administrative and support positions and more than 2,000 restaurant jobs.

The study also found that “Ohioans would see an aggregate decline in personal income growth of $4.7 billion in an average year, representing more than $900 per household.”

Eliminating Medicaid expansion would also slow state tax revenue. “The growth in state general fund tax revenue would fall by an annual average of $220.6 million, with more than a quarter coming from the personal income tax and the remainder coming from a combination of sales taxes and the Commercial Activity Tax,” according to the study.

As this brief was developed, policymaking discussions at the federal level shifted. For example, 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. Still, other proposed changes could impact the availability of health coverage options for Ohio, such as proposed changes to the Federal Marketplace that would limit the timeframe in which Ohioans with lower incomes could enroll in insurance through the Marketplace. KFF has more information on proposed federal changes to health insurance policy.

At the same time, there are proposals from the Ohio General Assembly to incentivize Ohioans enrolled in Medicaid expansion into Marketplace coverage and a provision remains in the Ohio Senate-passed budget plan that would require Ohio to automatically discontinue Medicaid expansion if the federal match rate drops below the current 90% amount. Ohio policymakers need time and flexibility to make informed decisions that support every Ohioan reaching their full potential and make Ohio a model of health, well-being and economic vitality.

The Health Policy Institute of Ohio has released a new policy brief that describes how the potential elimination of Medicaid expansion may impact Ohio’s state budget.

Click here to see the report, the third in a series of briefs that are part of HPIO’s 2025 Ohio Medicaid Expansion Study.

The brief analyzes the likely state budget effects of eliminating Medicaid expansion by:

• Examining costs to the state for healthcare services for people with Medicaid expansion coverage
• Providing estimates of the revenue and savings that result from Medicaid expansion coverage
• Identifying potential impacts on other state programs

The brief finds that without Medicaid expansion, Ohio’s uninsured rate for people below age 65 would be 80% higher, resulting in 435,000 more uninsured Ohioans. If Medicaid expansion coverage was not offered in Ohio, the state would no longer need to pay the 10% state share of Medicaid expansion costs. However, a combination of other factors would substantially reduce any state budget savings, as illustrated above.

“If Medicaid expansion coverage was not offered in Ohio, the state would no longer need to pay the 10% state share of Medicaid expansion costs,” according to the brief. “However, a combination of other factors would substantially reduce any state budget savings… For example, instead of saving $853 million in SFY 2026, the state would save only $116 million.”

Federal policymakers are considering many changes that could impact Ohio’s Medicaid program and Ohio’s state budget. At the same time, Ohio policymakers are considering discontinuation of coverage if the federal government reduces its share of funding for people in the Medicaid expansion group. The change could impact nearly 770,000 Ohioans.

To inform these decisions, HPIO is releasing a series of briefs that summarize data and research on the impact of Medicaid expansion on coverage, access, jobs and the state budget and economy.