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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.

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.”