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March 18, 2019

Ohio gets CMS' approval for Medicaid work requirements

Daily Briefing

    CMS on Friday approved Ohio's request to implement Medicaid work requirements, making Ohio the ninth state to receive federal approval for such requirements.

    Your cheat sheets for understanding health care's legal landscape

    The announcement came one day after lawyers for the Trump administration defended CMS' approval of Medicaid work requirements in court. U.S. District Judge James Boasberg on Thursday heard arguments in lawsuits filed against Medicaid work requirements in Arkansas and Kentucky. Boasberg said he intends to issue rulings in the cases by the end of this month.

    Ohio's Medicaid work requirements

    CMS gave Ohio permission to being implementing Medicaid work requirements in 2021. Under the state's approved Medicaid waiver request, Ohio will require most Medicaid beneficiaries ages 19 through 49 who are covered under the state's Medicaid expansion to attend school or job training, work, or volunteer for at least 80 hours a month to remain eligible for coverage. The requirements will not apply to Medicaid beneficiaries who are:

    • Disabled;
    • Caretakers;
    • Living in areas with high unemployment; or
    • Pregnant.

    Ohio will notify Medicaid beneficiaries if they are subject to the work requirements upon enrollment, according to Inside Health Policy.

    Medicaid beneficiaries who do not fulfill the work requirements will lose their coverage, but will be allowed to immediately reapply to enroll in Medicaid, The Hill reports. That stipulation differs from requirements in other states, such as Arkansas, which prohibit Medicaid beneficiaries who do not fulfill their work requirements from immediately reenrolling in Medicaid, effectively locking such beneficiaries out of Medicaid coverage for a specific period of time.

    Ohio estimates that more than 18,000 Medicaid beneficiaries—or about 50% of the beneficiaries who will be subject to the work requirements—will lose their coverage, The Hill reports.


    Rea Hederman, executive director of the Economic Research Center and VP of policy at The Buckeye Institute, called the approval "good news for Ohio and Ohioans." Hederman said, "The Buckeye Institute's research shows that with these work requirements many Ohioans will see higher earnings over their lifetimes and they will gain valuable work experience by remaining connected to the workforce." However, Hederman added, "With the approval of Ohio's waiver, it is now the responsibility of the state to develop a system that allows Medicaid enrollees to easily report their time working, and that ensures no one deserving of services is kicked-off the roles due to an overly cumbersome reporting process."

    However, Jesse Cross-Call, a senior policy analyst at the Center on Budget and Policy Priorities, said there is "mounting evidence that [the approval]  will lead thousands of Ohioans, including working people and people with serious health needs, to lose Medicaid coverage and become uninsured."

    John Corlett, president and executive director of the Center for Community Solutions, said the center is "disappointed … the federal government approved this waiver of federal law when so many operational details are missing or incomplete." Corlett said the state before implementing the waiver should establish a system that can provide monthly data on the number of Medicaid beneficiaries who are employed or who lost coverage and "monitor the impact of the waiver on the economic viability of safety net hospitals, community health centers and community mental health centers that serve a large percentage of Medicaid patients" (Coutré, Crain's Cleveland Business/Modern Healthcare, 3/15; Weixel, The Hill, 3/15; Romoser, Inside Health Policy, 3/15 [subscription required]).

    Where the states stand on Medicaid expansion

    The Supreme Court ruling on the Affordable Care Act (ACA) allowed states to opt of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.

    The Daily Briefing editorial teams have been tracking where each state stands on the issue since the ruling, combing through lawmakers' statements, press releases, and media coverage. In this latest iteration of our Medicaid map, we've determined each state's position based on legislative or executive actions to expand coverage to low-income residents using ACA funding.

    Get the Map

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