Medicaid expansion and the state budget

Medicaid expansion and the state budget

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.

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.

This 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

3 Key Findings for Policymakers

• Costs, revenue and savings. While the state currently pays 10% of Medicaid expansion costs, expansion also generates state revenue and produces state savings, resulting in an effective state share of 1.4%.
• Revenue from economic activity. Medicaid expansion is projected to generate over $1.1 billion over the next five years in state general revenue from personal income taxes, sales taxes and gross receipts taxes.
• Net savings. Discontinuing expansion would save substantially less than the state share amount, it would reduce federal funds coming to Ohio by over $42 billion over five years, and would leave an estimated 435,000 Ohioans without coverage.

About HPIO's 2025 Ohio Medicaid Expansion Study

HPIO has launched an expansive study on the potential impacts of the elimination of Medicaid expansion in Ohio. 

Since Ohio expanded Medicaid eligibility in 2014, hundreds of thousands of residents with lower incomes – including people who are working, parents, grandparents, veterans and caregivers – have gained access to medically necessary health care. As of March 2025, nearly 770,000 Ohioans are covered through Medicaid expansion. 

The federal Affordable Care Act (ACA) and a subsequent U.S. Supreme Court decision permitted states to expand Medicaid eligibility to adults earning less than 138% of the federal poverty level (FPL). The federal  government pays 90% of the cost of the Medicaid expansion group and the state government pays 10%. The proposed 2026-2027 biennial state budget (House Bill 96) would discontinue Medicaid expansion if the enhanced FMAP for Medicaid expansion drops below 90%. 

Resources

• More information about the study and links to additional briefs can be found on the 2025 Ohio Medicaid Expansion Study page.
• Eliminating Medicaid Expansion in Ohio in Response to Reduced Federal Funding, prepared for HPIO by the Urban Institute
• HPIO’s 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.
• Ohio Medicaid Basics 2025 provides an overview of the Ohio Medicaid program, including eligibility, covered services, spending and recent policy changes. 
• 4-page summary of all five briefs in this series

Facts and Figures

Use HPIO graphics and data in your work (presentations, social media posts, etc.). To use the data graphics in your presentations, click here to access the slides on Google Drive, click “File” and then “Download.” This will allow the option to download individual slides or the full deck into PowerPoint slides, a jpg, pdf or other available media files.

For graphics and slides from ALL phases of the study, see the 2025 Medicaid Expansion Study project page. 

Funders

This study was made possible by support from the bi3 Fund, Interact for Health, Mt. Sinai Health Foundation, The George Gund Foundation, the Harmony Project, The Columbus Foundation and HPIO’s other core funders.