Ohio is one of the states that has not yet expanded Medicaid under the Affordable Care Act (ACA), which means that many low-income Ohioans are still uninsured and lack access to affordable healthcare. Medicaid is a federal and state program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
The ACA expanded Medicaid to nonelderly adults with income up to 138% of the Federal Poverty Level (FPL) with enhanced federal matching funds. However, Ohio has not yet expanded Medicaid to this population, leaving many Ohioans without access to affordable healthcare.
Who Qualifies for Medicaid in Ohio?
According to the Ohio Department of Medicaid1, the following individuals may qualify for Medicaid coverage in Ohio:
- Be a United States citizen or meet Medicaid non-citizen requirements
- Individuals with low-income, including children, pregnant women, parents/caretakers, and the adult extension population
All Medicaid services are covered for children, parent/caretakers, and the adult extension population. Only ambulatory prenatal care (for example: doctor visits, lab tests, and ultrasounds) is covered for pregnant women who are not eligible for full Medicaid coverage.
As of late 2022, total Medicaid/CHIP enrollment in Ohio stood more than 3.3 million people, which was up 57% from 2013, before the ACA’s expansion of Medicaid took effect2. And nearly a million of those enrollees have coverage as a result of Ohio’s expansion of Medicaid under the ACA (this population is referred to as Group VIII, or the expansion group).
Medicaid Programs in Ohio
Ohio offers a variety of Medicaid programs to eligible individuals, including:
- Medicaid for Children
- Medicaid for Pregnant Women
- Medicaid for Families and Adults
- Medicaid for the Aged, Blind, or Disabled
- Medicaid for Long-Term Care
- Medicaid for Breast and Cervical Cancer
All of these programs provide comprehensive health coverage to eligible individuals, including doctor visits, hospital care, prescription drugs, and more.
COVID-19 and Medicaid in Ohio
In March 2020, Ohio Department of Medicaid (ODM) made a number of operational changes to its Medicaid program in response to the COVID-19 public health emergency (PHE) 3. These changes included taking advantage of the flexibilities offered to states such as increasing service limits for home-and community-based waiver services, expanding telehealth, and adding Health Care Isolation Centers (HCICs) as a nursing facility benefit to name just a few.
In December 2022, Congress passed the Consolidated Appropriations Act, 2023 (CAA). Per the CAA, the continuous coverage provision that prohibited states from disenrolling members from Medicaid will expire on March 31, 2023, and, as a result, states will once again resume routine eligibility operations. Ohio resumed its normal operations on February 1, 20233. This will cause some Ohio Medicaid members to be disenrolled from the program, with the first round of termination letters being mailed to those who are no longer eligible beginning in …
The Coverage Gap in Ohio
The coverage gap exists in states that have not adopted the ACA Medicaid expansion for adults who are not eligible for Medicaid coverage or subsidies in the Marketplace4. In Ohio, low-income adults without dependent children became eligible for the first time in 2014 due to the ACA’s expansion of Medicaid. However, Ohio has not yet expanded Medicaid to nonelderly adults with income up to 138% of the FPL, leaving many Ohioans without access to affordable healthcare.
According to the Kaiser Family Foundation4, in the remaining ten states that have not adopted the Medicaid expansion, an estimated 1.9 million individuals fall into the coverage gap. Adults who fall into the coverage gap have incomes above their state’s eligibility for Medicaid but below the lower limit for Marketplace premium tax credits.
Clearly, Ohio is one of the states that has not yet expanded Medicaid under the Affordable Care Act, which means that many low-income Ohioans are still uninsured and lack access to affordable healthcare. While Ohio offers a variety of Medicaid programs to eligible individuals, including Medicaid for Children, Medicaid for Pregnant Women, Medicaid for the Aged, Disabled, Medicaid for Long-Term Care, and Medicaid for Breast and Cervical Cancer, it has not yet expanded Medicaid to nonelderly adults with income up to 138% of the FPL.
This leaves many Ohioans without access to affordable healthcare, and many fall into the coverage gap. As healthcare continues to be a critical issue in the United States, it is important for policymakers to consider expanding Medicaid in Ohio and other states to ensure that all Americans have access to affordable healthcare.