New Federal Work Requirements Impacting Medicaid Coverage in Ohio
In Ohio, new federal work requirements scheduled for implementation in January 2024 could dramatically impact Medicaid coverage for nearly 90,000 residents in Cuyahoga County. These changes stem from regulations set by the Center for Medicaid and Medicare Services (CMS), mandating that adults between 19 and 64 earning up to 138% of the federal poverty level must complete 80 hours per month of work, education, community service, or another qualifying activity to retain their healthcare coverage. Alternatively, recipients may qualify by earning approximately $580 per month, equivalent to 80 hours at the federal minimum wage. Some individuals will qualify for exemptions.
The adjustments will affect individuals enrolled via the Medicaid expansion under the Affordable Care Act. Currently, Cuyahoga County has around 350,000 people enrolled in Medicaid. Ohio joins the ranks of the first states to enact these requirements, similar to those applied to Supplemental Nutrition Assistance Program (SNAP) beneficiaries. Kevin Gowan, Director of Job and Family Services, expressed his concerns regarding these changes.
Gowan noted that new SNAP requirements had cut benefits for thousands of residents who struggled to meet updated criteria. In May, fewer than 30 affected individuals met the new work requirements. “The need is still there,” said Gowan. “It’s just that fewer people are actually receiving SNAP.”
At its peak in September 2025, Cuyahoga County had 193,500 SNAP recipients, which decreased to around 181,300 by April. Gowan partly blamed this reduction on a federal shutdown causing payment delays and anticipated further declines as a three-month deadline looms for those unable to meet work requirements or exemptions.
Gowan also warned of a potential similar impact on Medicaid enrollment, which could increase the number of uninsured individuals when the new requirements take effect. He recounted a case involving a woman set to lose SNAP benefits just before she turned 65 and became exempt, illustrating the issues with rigid eligibility timelines.
The Medicaid changes also require more frequent eligibility reviews every six months instead of annually, which could amplify confusion, coverage loss, and administrative burdens. Additionally, retroactive Medicaid coverage will reduce from three to one month under expansion, and down to two months for other groups.
Cuyahoga County projects $7 million yearly in administrative costs for the SNAP program starting October 1, though Gowan noted this is still being assessed. Despite Governor Mike DeWine providing $12.5 million in state support, Cuyahoga County's share is merely $226,000, raising concerns over operational costs tied to SNAP error rates.
Ohio faces penalties if its SNAP error rate surpasses 6%, potentially costing $160 million to $480 million annually. The 2026 unreviewed statewide error rate is 5.7%. However, prior Cuyahoga County reviews showed error rates between 8% and 12.6%, mostly due to income changes and reporting errors. The county is required to conduct monthly accuracy reviews on 25 SNAP cases and use AI to spot discrepancies, but staffing cuts from 524 to 468 could hinder these efforts.
Gowan recognized the challenge of maintaining a reduced error rate amid staffing reductions and budget constraints but remains committed to achieving a rate below 6%.