Unless they qualify for an exemption, up to 450,000 Ohioans could be at risk of losing health coverage if Ohio’s proposed Medicaid work requirement waiver goes into effect. This estimate was calculated by The Center for Community Solutions based on the latest publicly available data on the employment status and health coverage of Ohioans. It far exceeds the fewer than 62,000 Ohioans who the Ohio Department of Medicaid (ODM) projects would lose coverage if the proposed waiver were implemented. The actual number of Ohioans who lose coverage will fall somewhere between those two figures.
Estimated impacts by county
Using the latest data on Medicaid enrollees on the ODM’s Annual Enrollment Dashboard and information contained in the proposed 1115 Waiver, Community Solutions produced estimates of the number of residents in each county who are likely to lose coverage in 2026 if the work requirement is implemented.
The unique Medicaid recipients enrolled in calendar year 2023 in the Expansion caseload group between 19 and 64 was used to establish the spread of enrollees across Ohio’s 88 counties. ODM estimated that “in CY 2026 no more than 61,826 individuals will be considered not exempt and not currently working.” We assumed the impact is evenly felt across counties, dividing the 61,826 impacted individuals among counties using the 2023 county shares.
In 2023, Franklin County residents comprised 12.8 percent of Ohio’s total Expansion working age population.
For example: In 2023, Franklin County residents comprised 12.8 percent of Ohio’s total Expansion working age population. Using that share of the total, 12.8 percent of the statewide estimated impacted members would be 7,898.
Many working-age Ohioans are at-risk for losing coverage
We also present the much larger estimates of working-age Ohioans at risk for losing coverage under this proposal, relying on the U.S. Census Bureau’s American Community Survey (ACS) 5-year estimates for 2023 which were released in December 2024. ACS provides self-reported data on health coverage and work status for the population ages 16-24 for each county. Community Solutions calculated the percent of working age residents in each county who said they had “Medicaid or other means tested coverage” for their health insurance and who did not work. We applied those percentages to the total number of working-age Expansion enrollees in 2023 to arrive at the number at risk.
The proposed waiver would impose work requirements on a narrower cohort of current Medicaid recipients than captured by the Census data. In particular, the Census counts people aged 16 and 17 and 55 to 64 who would be exempt from the proposed requirement. We have no way to accurately gauge the number of people in each county who would fall under the other vague exemption categories.
Pike County has the highest percent of the working-age population who is at risk.
Which counties will be most affected?
While the publicly available data does not line up with exemptions listed in the proposed Medicaid waiver, it indicates the counties whose residents may be most impacted by the proposed changes. Pike County has the highest percent of the working-age population who is at risk—15.9 percent—followed closely by Scioto at 15.2 percent. Eleven other counties are above 10 percent. Most of the counties with the highest share of at-risk working age adults have unemployment rates which are higher than the state average, suggesting that jobs may be more difficult to find in those communities.
Ohio’s working-age uninsured rate would nearly double with proposed changes
Ohioans denied Medicaid coverage due to work requirements will almost certainly become or remain uninsured. Since they are not working, they would have no access to employer sponsored coverage and have household incomes too low to qualify for premium subsidies through the Marketplace.
If all the at-risk residents are denied coverage, Ohio’s working-age uninsured rate would climb from the current rate of 8.8 percent to 15.3 percent—levels not seen since the early 2010s. Eighteen counties, most of which are small and rural, could see uninsured rates over 20 percent as a result. Being uninsured has been linked to lost productivity, lower wages, and higher employee turnover.
This is the exact opposite of the proposed waiver’s intended impact.
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