Ohio Medicaid Policy Changes to Increase Work Requirements, Redeterminations by 2026
Recent federal legislation, the One Big Beautiful Bill Act, signed into law changes Medicaid policy with implications particularly in Clark County, Ohio. This law introduces Medicaid work requirements for recipients aged 19-64, requiring a minimum of 80 hours per month of employment, community service, or education enrollment. It also mandates biannual Medicaid eligibility redeterminations for expansion enrollees, doubling the prior annual review cycle. Healthcare providers like Rocking Horse Community Health Center express concern that these requirements will increase administrative burdens and cause interruptions in patient coverage, potentially worsening health outcomes.
The legislation eliminates a federal Medicaid expansion funding increase effective December 2026 and permits Ohio to withdraw from Medicaid expansion if federal funding cuts occur. Governor Mike DeWine’s 2026-2027 budget includes provisions to cancel Medicaid coverage for around 770,000 Ohioans under these funding conditions. Medicaid expansion in Ohio currently covers approximately 36% of Clark County residents, including a substantial portion of children and working-age adults. Expansion has lowered the uninsured rate significantly, improved healthcare access, outcomes, and financial stability.
Critical exemptions in the new cost-sharing requirements include primary care, mental health, substance use disorder treatment, family planning, long-term care, and emergency hospital services. Retroactive Medicaid coverage is being limited, which may affect beneficiaries’ ability to maintain continuous care. The policy imposes cost-sharing on enrollees with income just above the federal poverty level, setting maximum out-of-pocket limits per service and annually.
Clark County faces logistical barriers for Medicaid recipients to comply with work requirements, including transportation challenges and cost-prohibitive child care, issues highlighted by local job and family services authorities. Approximately 10,000 Clark County residents on Medicaid could be affected by these new work and documentation requirements, but state health officials note that timelines and final rules remain pending federal guidance expected in mid-2025.
Healthcare providers anticipate an increase in uncompensated care due to Medicaid coverage losses, straining provider organizations financially. Rocking Horse Community Health Center serves a patient population that is about 60% Medicaid-covered and warns of increased gaps in chronic disease management, potentially leading to worsening morbidity and higher healthcare costs over time. The center also articulates concerns regarding the sustainability of care provision amid expected funding reductions.
The legislative changes also impact organizations providing reproductive health services; for instance, Planned Parenthood’s Medicaid-participating sites in Springfield and Hamilton will close due to federal policy barring abortion service providers from Medicaid. Meanwhile, recipients under Temporary Protected Status (TPS) are pursuing alternative legal statuses to maintain Medicaid eligibility, reflecting administrative complexities for immigrant populations.
Historical parallels are drawn to welfare reform programs of the 1990s regarding work requirements, with state officials emphasizing the necessity for effective implementation and support for affected residents. The dynamic policy environment requires Medicaid administrators to prepare operational adjustments to manage redeterminations and compliance documentation efficiently, mitigating gaps in coverage.
In sum, changes to Medicaid funding, eligibility redetermination frequency, work mandates, and cost-sharing requirements in upcoming years in Ohio pose significant challenges for health access continuity. Providers and policymakers need to monitor these impacts closely, especially in regions like Clark County where Medicaid enrollment is high and social determinants of health significantly influence patient outcomes. The potential increase in uninsured individuals and uncompensated care demand foreshadows broader financial and public health implications. State and local agencies will require strategic planning to balance regulatory compliance with sustaining healthcare quality and accessibility.