Ohio officially has asked federal officials for permission to require hundreds of thousands of Ohioans on Medicaid to hold a job or enroll in education programs in order to keep their coverage.
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Gov. Mike DeWine and Republican state legislative leaders on Friday sent a letter to U.S. Health and Human Services Director Robert F. Kennedy Jr. asking for permission to impose the work requirements. The letter is part of a formal process called a waiver request, through which states must get federal permission to make major changes to Medicaid, which is a government healthcare program for the poor and disabled.
If approved, the new rules only would apply to Ohioans between the ages of 18 and 54 covered through what’s called Medicaid expansion. This refers to adults who are covered because they make less than 138% the federal poverty level, or $44,367 for a family of four, and not because of disability, pregnancy or age.
State projects that 61,000 people will lose coverage
The new rules would require apply to people covered by Medicaid expansion, which Ohio passed in 2013. There would be exceptions for people 55 and older, for people who are in drug or alcohol addiction treatment or who have “intensive physical health care needs or serious mental illness.”
Currently, about 776,000 people are covered through Medicaid expansion, although state figures don’t clearly state how many of those people are younger than 55. State officials project that 61,000 people will lose coverage because of the new rules. Advocacy groups have projected the number actually might be significantly greater.
In Cuyahoga County, roughly 100,000 people are covered through Medicaid expansion. The change would translate to 7,400 people losing coverage, extrapolating from the state’s estimates. In Summit County, around 40,000 people are covered through Medicaid expansion, meaning around 3,200 people could lose coverage.
The state previously got federal approval for similar work requirement rules in 2019 under then-President Donald Trump. But then-President Joe Biden revoked the approval in 2021. As part of a state budget bill, Republican lawmakers voted more than a year ago to ask again by the end of February 2025.
Trump, who became president again in January, is expected to be supportive of Ohio’s request.
How will the work requirements work?
If approved, the changes will take effect in January 2026.
Sometime before then, more specific rules will need to be written dictating exactly how the new rules will be administered.
But Kevin Gowan, director of Cuyahoga County’s Department of Job and Family Services, said the bureaucratic process could end up looking similar to existing work requirement rules for other programs, such as for the Supplemental Nutrition Assistant Program, also known as food stamps.
If and when the new work requirements go into effect, people signing up for Medicaid will have to prove they’re meeting the work requirements to get enrolled.
For existing enrollees, officials will use the information the state collects through its benefits sign-up process, along with other data, to see who either meets the new work requirement or is exempt from it.
Then, county caseworkers will be assigned to review those who are left. These enrollees might be asked to submit paperwork documenting that they are meeting the new requirements. Those who can’t do so will lose coverage.
Responding to public questions about monitoring and compliance, the state’s final official waiver says enrollees won’t have to regularly resubmit documentation proving they’re still complying with the work requirements.
But enrollees may have to re-verify their eligibility annually, Gowan said, and as they are now, they will be required to notify their county of any changes in their circumstances, according to the final waiver.
Gowan said administering the new requirements will be extra work for county JFS caseworkers. “How much is going to be heavily dependent on the volume, and all I have now is the state’s estimate,” Gowan said.
Why is the state doing this?
State officials describe the proposed work requirement as a way to promote wellness and economic productivity, saying research shows people who have jobs have better health. Republicans have supported work requirements in general as a way to promote self-sufficiency and reduce Medicaid costs while not making more drastic cuts to the program.
Separately, congressional Republicans are considering significant cuts in Medicaid funding, leading state officials to prepare for the possibility.
“We are dedicated to delivering high-quality healthcare to millions of Ohioans every day, empowering them to take control of their own health,” Maureen Corcoran, DeWine’s state Medicaid director, said in a statement announcing Friday’s waiver request. “By encouraging them to seek employment, we not only enhance their quality of life, but also contribute to healthier communities and a thriving economy in Ohio.”
Democrats and other critics have said the requirements will cause people to have poorer health, the opposite of what state officials say their goal is, and become less productive as a result.
Andrew Tobias writes for Signal Statewide covering state government and politics from Columbus.