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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.

The Health Policy Institute of Ohio has released a new policy brief that describes the role of Medicaid expansion in improving the health and well-being of parents, caregivers and their children.

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

Medicaid provides health insurance coverage to millions of Ohioans who would otherwise be uninsured. In 2014, Ohio expanded Medicaid coverage to hundreds of thousands of adults with low incomes – including people who are working or veterans and parents, grandparents and other caregivers. As of March 2025, nearly 770,000 Ohioans are covered through Medicaid expansion.

As parents were enrolled through Medicaid expansion, their children who were previously eligible were also enrolled in the program. Ohio experienced a rapid decline in the state’s child uninsured rate following its decision to expand Medicaid, to a low of 4% in 2016 (as illustrated above). Despite the state’s child uninsurance rate increasing 50% since 2016, it remains lower than the ten states that have not expanded coverage.

Ohio policymakers are considering discontinuation of Medicaid expansion coverage if the federal government reduces funding for this group. To inform the decision, HPIO is releasing a series of briefs that summarize data and research on the potential impact of the change.

Data included in recent analysis from the Health Policy Institute of Ohio shows that mental health treatment rates for people with serious mental illness are higher for Medicaid-enrolled adults compared to those who are uninsured or who have private insurance, as illustrated above.

Ohio policymakers are considering discontinuation of 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. This decision would impact approximately 770,000 Ohioans.

HPIO recently released a new brief on the impact of Medicaid expansion in Ohio on access to mental health and substance use disorder treatment. It is first in a series of policy briefs in HPIO’s 2025 Ohio Medicaid Expansion Study.

Behavioral health conditions are common among Ohioans, including those with Medicaid coverage. In 2024, 40% of Ohioans enrolled in Medicaid expansion had a primary mental health or substance use disorder (SUD) diagnosis.

“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.”

Cannabis use among Ohio teens was relatively low in 2021, with Ohio ranking 10thbest in HPIO’s 2024 Health Value Dashboard.

However, the Dashboard found that “with the recent legalization of recreational use for adults, policymakers will have to consider strategies to ensure that use does not increase among teens.”

One evidence-based strategy to support public health and safety is to reinvest tax revenue from addictive substances into prevention, treatment and recovery.

In current law, 25% of cannabis tax revenue supports a Substance Abuse and Addiction Fund managed by the Ohio Department of Mental Health and Addiction Services, as illustrated above. The Governor's proposed version of the next state operating budget reduced that percentage to 14%, and the house-passed version eliminated any specific allocations to addiction prevention, treatment and recovery.

HPIO has posted a revised version of its recent policy brief on the impact of Medicaid expansion on mental health and substance use treatment access.

After HPIO released the brief, the Ohio Department of Medicaid discovered that the expenditure amounts they provided were incorrect because they included expenditures for a two-year lookback period (i.e. 2023 and 2024 expenditures labeled as CY2024). We have revised our brief with the corrected data. We will also be posting revised spreadsheets with county-level data.

The revised analysis continues to show that Ohio receives substantial federal funding for behavioral health services for the Medicaid expansion population. 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.

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 $627 million a year.

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 discontinuation of 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. This decision would impact approximately 770,000 Ohioans. 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 future of the program.

Data included in HPIO’s “Ohio Medicaid Basics 2025” shows that most Ohioans have employer sponsored health coverage, as illustrated above.

Many Ohioans who have low incomes enroll in Medicaid, the second-most common source for coverage in Ohio, because other health insurance coverage is unavailable, too expensive or does not provide coverage for needed services, such as long-term services and supports.

Published every other year since 2005, to coincide with the biennial budget process, Ohio Medicaid Basics provides an overview of the Ohio Medicaid program, including eligibility, covered services, spending and recent policy changes. 

As Ohio policymakers consider discontinuation of Medicaid expansion coverage if the federal government reduces funding for this group, HPIO is planning to release findings from a comprehensive, data-driven study to describe how the 2014 Medicaid expansion impacted coverage, access and affordability and estimate the future impacts of discontinuing coverage for the expansion population.

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