Late last year, the Ohio Department of Medicaid (ODM) released a draft of the Group VIII Demonstration Waiver, which includes details on the program, eligibility groups, benefits and cost sharing requirements, budget neutrality projections/financing, and delivery system payment. The waiver also provided background on how House Bill 33 (HB 33) required these changes: “Requiring new eligibility limitations for the adult Medicaid expansion population under 1902(a)(10)(A)(i)(VIII) of the Social Security Act (Group VIII).” If the waiver is implemented, an individual needs to at least meet one of the following criteria to be eligible for enrollment in Group VIII:
- At least fifty-five years of age
- Employed
- Enrolled in a school or occupational training program
- Participating in a drug addiction or alcohol program
- Have severe mental illness or intensive physical health needs
The 30-day public comment period begins
During this time, interested parties and stakeholders have a 30-day public comment period to provide input on the Group VIII 1115 Demonstration Waiver Application. On December 17, 2024, ODM posted a public notice indicating that the 30-day public comment period had begun. The 30-day public comment period consisted of two public hearings; the first on January 3, 2025, and the second which already occurred on January 9, 2025.
Initially, the public comment period was set to run to January 16, 2025, however ODM extended the period because of requests from the public. The period extension requires all comments to be submitted by 5 p.m. on January 21, 2025.
The period extension requires all comments to be submitted by 5 p.m. on January 21, 2025.
Ohio submits to the Feds
After the 30-day public notice and comment period ends, Ohio will submit an application to the Center for Medicare and Medicaid Services (CMS) no “…Earlier than February 1, 2025, and not later than March 1, 2025”. A decision on the application’s completeness will be decided within a 15-day period of receiving the application.
Communication with the state of Ohio will come in the form of a written notice, which starts the Federal public comment period if the application is determined complete. If the application is not determined to be complete, CMS will contact the state regarding any missing elements in the application.
Federal public comment period begins
Within 15 days of receiving an application, CMS will inform Ohio on the receipt of the completed application, and the start date of the 30-day Federal Public Notice period. This period will give an opportunity to stakeholders and the public at large to present comments.
CMS will not act on the demonstration waiver until at least 15 days after the comment period has ended. Comments can be submitted after the 30-day period, however there is no guarantee that the submission would be reviewed due to time constraints.
Federal decision made
If the application is approved, Ohio will receive an award letter and correspondence from CMS about the waivers, authorities responsible for expenditure, terms and conditions. If the application is denied, a rejection letter will be sent to the state. Regardless of the decision, CMS will disclose a record of information on its website with Ohio’s demonstration application, and any written comments directed to CMS and relevant responses. Information on the approved or rejected status will also be available, consisting of the aforementioned documents.
What will the Feds Decide?
We cannot give any certain answer on what the feds will decide, but it is important to note that the work requirements would affect recipients and providers across the state and impede access to care for many Ohioans. There have been public comments made by leadership in both chambers of Congress and from the Trump administration in support of work requirements and other significant changes to the Medicaid program, which positions these changes favorably while being reviewed on the federal level.
The projected date for implementing the Work and Engagement Requirement is January 1, 2026.
When does this go into effect?
The projected date for implementing the Work and Engagement Requirement is January 1, 2026. Any individual who applies for Medicaid on that date or after it will be contacted through the application process their eligibility status for Medicaid. Recipients enrolled in Group VIII before January 1, 2026, will have their eligibility evaluated under the new requirement at the next renewal date.
Implementation
Within six months after the implementation of the demonstration, Ohio must hold public forums that allow for comments on the progress of the demonstration program, allowing stakeholders and the public to provide comments which will be included in quarterly reports along with the annual report sent to CMS.
READ MORE: Expected impacts
Community Solutions has published information on the populations that would be affected by the proposed Medicaid work requirement. From our research, we identified crucial populations throughout Ohio that would be at risk of losing health coverage.
