Analysis of Ohio’s report on Medicaid expansion

On Tuesday, August 21, the Ohio Department of Medicaid (ODM) released the second “assessment” of the Medicaid expansion as a follow-up to the first, General Assembly required, assessment from 2016. In this document the ODM found the following:


  • Employment for enrollees went up 15%, meaning 1 in 2 expansion enrollees are working
  • The most common reason for disenrolling from the program was due to finding employment
  • Ninety-three point eight percent of enrollees were employed, in school, the primary caretaker in the household, in treatment for addiction, or have some other, debilitating health issue


  • Nearly 1 in 3 reported improved health, including better access to treatment for hypertension, high cholesterol and diabetes
  • Twenty-six thousand Ohioans quit smoking, citing Medicaid as the reason they were able to enroll in cessation
  • Enrollees reported improved mental health
  • Significant access to medication assisted therapies and other treatment for addiction


  • Ohio’s uninsured rate was cut in half, driven primarily by expansion
  • Half of Ohio counties had 17% of their populations enrolled at some point
  • Provider participation in Medicaid increased
  • Disproportionate enrollment in Appalachian and major urban counties


  • Primary care utilization increased by 10% since the 2016 report, particularly in Appalachia
  • Emergency room utilization decreased 17%
  • Parents could more easily afford food and rent, medical debt was decreased

Expansion was one of the most momentous policy choices of the Kasich administration, resulting in significant political and policy scrutiny from the General Assembly, hence the requirement for the report. What this assessment shows is consistent with the previous assessment data that expansion has improved outcomes, lowered costs and increased access. However, the uniqueness of this report is in the ways in which it shows how Medicaid has acted as an efficient work support program for low-income adults from rural and urban communities alike.

When the first expansion assessment came out, there were nearly 690,000 enrollees in the program – there are now fewer than 640,000. While all of these enrollees are not the same people, exactly, the decrease bolsters the conclusions from the assessment that expansion is acting as a temporary economic support for people who are between jobs, going to school, facing health challenges (including addiction) or serving as the primary caretaker in the household. What’s more, given the make-up of where enrollment is taking place, and who is enrolling, it appears the program serves as a key resource for families who are living in areas where there are less opportunities for economic self-sufficiency.

Ohio’s uninsured rate was cut in half, driven primarily by expansion

As the legislature gears up for a new budget, the question now focuses on the ability for the state to manage the cost of expansion. As it stands, the federal matching rate is still very high and Ohio has a built in “kill switch” if that were to ever change, meaning the new question revolves around evaluating the return on the investment of expansion as a policy choice. The assessment data, now over time, shows that outcomes are improving, people are more work-ready, and that utilization patterns are shifting towards primary care. The data also shows expansion is a key resource in addressing the opioid crisis and increasing financial security for parents. Hopefully, legislative focus on cost containment can now turn to the ways expense manifests in other parts of the program (think pharmacy benefit managers) as opposed to the issue of eligibility expansion.

Click here to read ODM’s report.