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Ohio Medicaid Proposal Would Mean Coverage Losses, New Costs for Local Governments

Ohio has submitted a waiver proposal to the Centers for Medicare and Medicaid Services (CMS) to impose rigid work requirements on Medicaid beneficiaries who gained coverage through the Affordable Care Act’s Medicaid expansion. Ohio acknowledges that its proposal will cause 18,000 beneficiaries to lose their Medicaid coverage — although the actual number will likely be higher — and many of them would end up uninsured. Ohio’s counties would also face millions in new costs to administer the program.

During the state public comment period on the proposal, Ohio received over 900 comments and 93 percent of them opposed it. Once CMS deems Ohio’s application complete, a 30-day federal public comment period will begin.

Ohio’s proposal is similar to waivers that the Administration has approved in Arkansas, Indiana, and Kentucky in that Ohioans would have to work or participate in work-related activities an average of 20 hours per week, or 80 hours a month, or lose coverage. Among those who may be exempt are people over 50 and those caring for a child, in treatment for a substance use disorder, or in school at least half time.

Ohio says its proposal won’t affect working people. But while most adult Medicaid beneficiaries work, many work in industries like retail, restaurant and food services, and construction, in which hours are volatile and gaps between jobs are common. As a result, many working Ohioans also risk losing coverage under an 80-hour-per-month work requirement like Ohio’s.

The proposal would hurt the state in other ways as well. For example, since Ohio’s counties administer its Medicaid program, they would foot the bill for the new case management and administrative costs that the Cleveland-based Center for Community Solutions projects will total $378 million over five years.

While Ohio Medicaid officials say their goal is to boost employment, the state says it won’t offer the necessary services to help Medicaid beneficiaries connect with job opportunities. The state notes, for example, that access to reliable transportation is a major obstacle for low-income people, and it has requested federal matching funds to cover transportation services. CMS made clear when it announced its work requirement policy, however, that it won’t provide federal money for beneficiary supports such as child care or transportation assistance.

Ohio’s own reports show that its Medicaid expansion has benefited both those who have gained coverage and the state as a whole. Enrollees have reported a decline in unmet health needs, as well as better access to mental health services and treatment for chronic health conditions. And 75 percent of those who were unemployed and looking for work when they gained coverage said Medicaid made their job search easier. Among those who were already employed, half said Medicaid made it easier to stay working.

Ohio should build on its recent gains in coverage and access to care, rather than pursue a policy that will threaten them.