Implementation of Medicaid work requirements in Ohio

A year ago, HR 1, the federal reconciliation bill that is sometimes referred to as the “One Big Beautiful Bill Act,” enacted significant changes to state Medicaid programs. While some provisions of the law went into effect immediately, implementation of others will take place over the next several years. This policy update focuses on Ohio's implementation of the HR 1 provision mandating that all states establish work requirements for Medicaid expansion eligibility by Jan. 1, 2027.

Work requirements at a glance

Who is affected?

Medicaid expansion (Group VIII) enrollees (about 700,000 Ohioans)

What is required?

80 hours per month of:

• Employment
• Community service
• Educational programs
• Work programs

Who is exempt?

Individuals who:

• Are pregnant
• Have special medical needs
• Are medically frail
• Receive substance use treatment
• Are a parent/caretaker of a young child or person with disabilities
• Meet other limited categories

Projected impact

According to new RAND estimates, in the next decade, work requirements may lead to: 

Learn more

More information about work requirements in Ohio can be found in HPIO’S September 2025 policy explainer. Analysis about the overall impact of federal policy changes on Ohio can be found in HPIO’s series on healthcare access and affordability and federal health policy impact on Ohio.