Medicaid
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Feds reject Ohio's Medicaid work requirement program

August 16, 2021
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As of August 10th, 794,806 Ohioans received their primary source of health coverage through Ohio’s Medicaid expansion. On that same day, the Centers for Medicare and Medicaid Services (CMS) sent a letter to the Ohio Department of Medicaid notifying them that their previously approved 1115 Community Engagement (work requirements) waiver was withdrawn.

 As of August 10th, 794,806 Ohioans received their primary source of health coverage through Ohio’s Medicaid expansion.

Since Ohio extended coverage to able-bodied adults without dependents (also known as “Group VIII”), policymakers in the Ohio General Assembly have pursued policies to make that coverage harder to attain, notably mandating the Ohio Department of Medicaid (ODM) to seek federal approval to impose cost sharing and workforce participation reporting requirements on beneficiaries. In 2016, this came in the form of Healthy Ohio, which was soundly rejected by CMS on the grounds it did not “achieve the objectives of the Medicaid program.” However, with the 2016 election, we saw a change in priorities at the federal level, and work requirements once again became a focus in Ohio and across the country.  

As opposed to the Obama administration, the Trump administration actively encouraged states to seek work requirements in their Medicaid programs; but the Trump administration’s CMS was also led by Administrator Seema Verma, the architect of Indiana’s groundbreaking effort to impose such requirements. In the years following, a number of states sought waivers, many of which were accepted, though many also faced significant challenges with Arkansas, Kentucky, Michigan and New Hampshire having their proposals set aside by the courts. Despite these legal challenges and ethical concerns regarding Verma’s personal expenditures, the Trump administration pushed ahead, quickly issuing a number of regulations to protect their efforts before the Biden administration took hold of CMS. Immediately following inauguration, the Biden administration rescinded that guidance and issued notices to states with work requirements, including Ohio, that such proposals were under review. And, unsurprisingly, CMS notified Ohio, as it did with Utah and South Carolina, the previously accepted work requirement waiver was no longer permitted and Ohio could not move forward.

 It should be noted that Ohio had hundreds of pieces of testimony and analyses from policy experts, providers, advocates and patients decrying work requirements in Ohio Medicaid.

It should be noted that Ohio had hundreds of pieces of testimony and analyses from policy experts, providers, advocates and patients decrying work requirements in Ohio Medicaid, citing the legally specious arguments platforming the waivers, the broad disenrollment the policy would create and the incredible bloat it would manifest in government expense. In its letter to Ohio Medicaid, CMS highlighted those same concerns and built on policy arguments supporting the position that work requirements do not support the statutorily defined objectives of Medicaid. Notably, CMS stated the waiver would lead to significant disenrollment, that it would have little impact given the fact most enrollees are already meeting the requirements and that, instead, the requirements would only exacerbate Ohio’s challenges in its existing, underperforming and malfunctioning eligibility system. Beyond this, CMS made the appropriate connection between the benefits of expansion and the impact of Covid-19, highlighting the disproportionate impact a loss of coverage would have on low-income and racial/ethnic minority enrollees’ ability to remain economically resilient, especially as we continue to manage the economic fallout of the pandemic’s impact. As the premise of work requirements ties labor participation to overall health, the letter’s argument rightly points out the evidence supporting coverage’s role in creating economic mobility, underscoring the data from Ohio showing the positive benefits expansion has had on reducing debt, promoting education, diminishing social risk and saving Ohio taxpayers money through primary care.  

Much is to be determined, however. The Supreme Court may still weigh in on the legality of these waivers and, with Governor DeWine already expressing his disappointment, the Statehouse will likely have a strong reaction against this decision, politically. But all Ohioans would be wise to understand just how positive expansion has been to our state.

 Expansion has slashed medical debt, saved taxpayer money and significantly improved the health and economic mobility of Ohioans.

Expansion is the primary source of funding for opioid addiction services in Ohio. Expansion provides women the critical coverage they need to successfully carry a birth to term and care for their child in the year following delivery. Expansion has slashed medical debt, saved taxpayer money and significantly improved the health and economic mobility of Ohioans. Expansion has been a lifeline to rural communities, ensuring small providers and hospitals are able to stay afloat.  

Ohio policy makers should concern themselves less with imposing work reporting requirements and focus instead on boosting work supports; policies like a state refundable earned income tax credit, and boosts in funding for public transit, workforce training, and child care are the kinds of strategies that will actually help people get and maintain employment.

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