Recent federal health policy changes, including provisions of the 2025 reconciliation bill H.R. 1, will impact services related to health care, housing, food access and more. HPIO’s Federal Health Policy Update provides an overview of relevant changes to national health policy (e.g., bills passed, implementation deadlines, new guidance) and how Ohio could be impacted. It also highlights state policy decisions that will need to be made in response.
If you have questions about the newsletter or have suggested tools or resources you would like to see included in future editions, please contact Nick Wiselogel, HPIO’s Vice President of Communications and Design.
► HPIO graphic: Medicaid work requirements
With federal work requirements set to go into effect in January, Ohio policymakers likely will be faced with a sharp increase in the state’s uninsured rate among Ohioans who have health challenges.
According to new projections from healthcare consulting firm Manatt, 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, as illustrated above.
HPIO recently released a policy update on the implementation of Medicaid work requirements in Ohio. The publication focuses on Ohio's implementation of the H.R. 1 provision mandating that all states establish work requirements for Medicaid expansion eligibility by Jan. 1, 2027.
The 2014 expansion of Medicaid eligibility in Ohio contributed to the 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.
The new estimate from Manatt includes an additional 64,000 people losing coverage after an interim federal rule was released earlier this month that includes stricter criteria for receiving a medical frailty exemption. HR1 states that medically frail individuals, including people who are blind or disabled, or have a substance use disorder, disabling mental disorder, disability that significantly impairs activities of daily living or serious or complex medical condition, are exempt from meeting the work requirement.
Earlier Centers for Medicare & Medicaid Services (CMS) guidance indicated that states could use diagnoses to identify medical frailty. The new rule adds a further requirement: Individuals must show that their condition significantly impairs their ability to comply with the work requirements. That additional test does not appear in the statute and will require states to assess not only if someone has a serious condition, but whether that condition limits their ability to work, volunteer or attend school.
► Federal policy tracker
Upcoming federal policy implementation considerations:
Medicaid work requirements notification begins
(July-September 2026)
H.R. 1 requires all states to implement work requirements in their Medicaid programs beginning in January 2027. States must begin outreach to enrollees about work requirements at least three months in advance. According to the Ohio Department of Medicaid, outreach efforts are expected to begin in July and August 2026.
Related HPIO resources:
- Policy update: Implementation of Medicaid work requirements in Ohio
- Medicaid Work Requirements in Ohio
Restricted immigrant eligibility for Medicaid
(Oct. 1, 2026)
Some types of lawfully present immigrants, including refugees and asylees, who were previously eligible for Medicaid, will no longer be eligible starting in October 2026. Immigrants face significant healthcare access barriers, affordability challenges, language and cultural barriers, immigration-related fears and discrimination.
Related HPIO resources:
- Access to care for immigrants in Ohio
- Major federal and Ohio healthcare access and affordability policy changes
Changes to SNAP Funding
(Oct. 1, 2026)
H.R. 1 made substantial changes to the Supplemental Nutrition Assistance Program (SNAP) that will affect eligibility for the program, as well as how Ohio and other states administer it. Beginning in October 2026, the federal government will cover 25% of administrative costs, rather than 50%, resulting in a $67 million loss for Ohio, according to estimates from the Ohio Department of Job and Family Services. More than 70% of this revenue ($47.4 million) is typically allocated to counties to manage the program locally, though some counties already shoulder part of the administrative costs.
Related HPIO resource:
Rural Health Transformation program year 1 fund distributions
(ongoing)
In the first year of the federal Rural Health Transformation (RHT) Program, Ohio received approximately $202 million, one of the lowest amounts in the nation based on rural population size. Year one funding runs through Sept. 30, 2026, and CMS expects states to submit their first formal reports beginning Oct. 1, 2026. According to the Ohio Department of Health’s RHT site, there are two remaining opportunities for applications for Ohio’s initial RHT funds: Rural health peer group funding (due Aug. 19) and rural Ohio clinically integrated networks and rural health innovation hubs (due Sept. 1).
Related HPIO resources:
► Resources and tools
Medicaid
- Changes to Medicaid financing in Ohio — HPIO
- Data snapshot: Medicaid and home- and community-based services in Ohio — HPIO
- H.R.1 Medicaid Implementation: An Administrative Cost Monitoring Guide for States — State Health & Value Strategies (Princeton University)
- The Medical Frailty Exemption from Medicaid Work Requirements: Key Takeaways from the CMS Interim Final Rule — KFF
- New State-by-State Medicaid and CHIP Tracker Shows Declining Enrollment as H.R. 1 Cuts Loom — Georgetown University McCourt School of Public Policy, Center for Children and Families
SNAP
- SNAP Policy Navigator — National Conference of State Legislatures
- H.R. 1 and the Supplemental Nutrition Assistance Program (SNAP): What Counties Should Know — National Association of Counties
- A Look at the Intersection of SNAP and Medicaid as States Implement Medicaid Work Requirements — KFF
- State Strategies to Improve SNAP Payment Accuracy: Early Lessons from the First Year of H.R. 1 Implementation — American Public Human Services Association
ACA marketplaces
- Data snapshot: Updated Ohio enrollment in the federal ACA marketplace — HPIO
- How Has ACA Marketplace Enrollment Changed Across States in 2026? — KFF
- Marketplace Pulse: Increase in Exits by Individual Market Insurers — Robert Wood Johnson Foundation
Rural Health Transformation Program
- RHTP RFP Status by State — National Rural Health Association
- From Planning to Action: Tracking Which State Agencies Are Leading RHTP Implementation — State Health & Value Strategies (Princeton University)
- H.R. 1 Funding Cuts Will Overshadow Gains from the New Rural Health Transformation Program — The Commonwealth Fund
- Marketplace Pulse: Rural Health Transformation Program Will Not Meet the Moment for Rural Healthcare Systems — Robert Wood Johnson Foundation
Other
- How States Are Assessing the Impact of Federal Policy Changes — Pew Charitable Trusts
- The potential impact of the Trump administration policies on health research in the USA — The Lancet
- Data-Driven, Interactive Map Shows Local Economic Impact of Cuts to Federal Funding for Health Research — Annenberg School for Communications, University of Pennsylvania
- The effect of recent changes in federal preventive guidance on patients and primary care practice — American Journal of Preventive Medicine
- How H.R.1 Impacts Coverage for Non-Citizens — State Health & Value Strategies, Princeton University
- Tracking Key Mental Health and Substance Use Policy Actions Under the Trump Administration — KFF
