News Releases

The Center Supports Continuous Medicaid Eligibility for Young Children

Medicaid covers more than 72 million Americans, including 3 million Ohioans. Hospital advocates are closely watching – and voicing their support for the program – as both the Ohio General Assembly and the U.S. Congress each work on their respective budget bills that could impact coverage, eligibility and reimbursement for the joint federal-state program.

As an important source of health coverage for millions of people, Medicaid is also a significant payor for healthcare providers. Those that serve a disproportionately high number of Medicaid enrollees, including hospitals in both urban and rural communities, are particularly vulnerable to potential changes to eligibility and reimbursement.

A recently passed U.S. House budget resolution calls for the Committee on Energy and Commerce, which is the committee of jurisdiction for Medicaid, to make cuts of at least $880 billion by 2034. While the resolution does not specifically mention cuts to Medicaid, it is widely believed the program will be targeted.

Trigger Provision in Ohio

Nearly 770,000 Ohio Medicaid recipients currently face an uncertain future as Governor Mike DeWine’s state budget bill includes trigger language that could end Medicaid expansion funding if the federal government reduces its share of funding below its current 90%. These cuts would be detrimental to recipients, particularly vulnerable populations.

The trigger language states that if the federal share of funding for the expansion population is reduced from its current 90%, the state “shall immediately discontinue” coverage for those individuals. The Center is advocating a language change from “shall” to “may” to allow the DeWine Administration time to analyze available options and offer the greatest number of Ohioans access to care.

The Center has also voiced support for continuous eligibility for children and has shared concerns about the state’s proposed work requirements.

The Center’s Support for Multi-Year Contonious Eligibility Waiver

In a letter to the Ohio Department of Medicaid, The Center for Health Affairs expressed support for the Multi-Year Continuous Eligibility Section 1115 demonstration waiver. This waiver would ensure children in Ohio remain continuously enrolled in Medicaid from birth until the first month of their fourth birthday without interruption due to administrative hurdles and regardless of changes in family circumstances.

The Center states that “regular well-child visits, early screenings, and timely interventions are all critical to ensuring children grow up healthy and ready for school. Research has demonstrated that continuous coverage is linked to better cognitive and developmental outcomes, improved management of chronic condition, and fewer hospitalizations or emergency room visits later in life.”

Continuous enrollment simplifies the process for families by eliminating the need for repeated paperwork, reducing stress and uncertainty for caregivers, and even lowers administrative costs for the state by decreasing the workload associated with processing re-enrollment applications and managing churn.

Additionally, continuous coverage can lead to lower overall healthcare costs over time and lower rates of hospitalization. Children are less likely to develop chronic conditions or require extensive emergency care when they receive uninterrupted access to healthcare. These improved health outcomes in early childhood have been linked to higher educational attainment and, ultimately, better earnings in adulthood.

The Impact of Cutting Medicaid Expansion in Urban and Rural Communities

Cuts to Medicaid expansion would have far-reaching consequences—not only for individuals losing coverage, but also for hospitals, particularly those in urban and rural areas that rely heavily on Medicaid reimbursements.

People losing coverage would be forced to turn to the public marketplace or go uninsured, jeopardizing both community health and economic stability. Across the U.S., including Ohio, many rural clinics, community health centers, and safety-net hospitals depend on Medicaid to sustain operations. Ending Medicaid expansion would force these providers to reduce services and cut costs, threatening access to care.

Hospitals in low-income communities already operate with limited resources. Without Medicaid expansion, they would face a surge in uncompensated care and a growing number of uninsured patients—straining an already fragile public health infrastructure. In Ohio, many rural hospitals operate on thin profit margins and cannot absorb additional financial burdens.

The impact is already visible. In the first quarter of 2025, 10 hospitals closed nationwide, compared to 25 in all of 2024 and 14 in 2023. Despite their critical role in delivering high-quality care, rural hospitals remain especially vulnerable due to remote locations, staffing shortages, and limited funding—making closures more likely and further limiting access to care for underserved populations.

Urban safety-net hospitals would also be affected. In Cleveland, The MetroHealth System—where more than 75% of patients rely on government insurance, are uninsured, or are employees—would face significant strain. Cuts to Medicaid would threaten its ability to serve the region’s most vulnerable residents.

Lawmakers Propose Work Requirements for Medicaid Expansion Recipients

Another proposal that would jeopardize coverage is work requirements. Ohio lawmakers have requested federal approval to require individuals in the state’s Medicaid expansion group to work at least 80 hours per month. Exceptions would be made for those over 55, enrolled in school or job training, in a recovery program, or dealing with a serious physical or mental illness.

The Center for Community Solutions estimates up to 450,000 Ohioans could be at risk of losing coverage under such a waiver. Ohio lawmakers initially submitted a waiver for work requirements to the Trump administration in 2019, which was approved. The COVID-19 pandemic delayed its implementation, and in 2021, the Biden administration reversed the approval.

For more information, read The Center’s letter to the Ohio Department of Medicaid, and The Center for Health Affairs’ 2025 policy priorities, including those related to the Medicaid program, and watch the latest Policy Points video.

To learn more about Ohio Medicaid news, including how to receive the new state ID — required for online access to Ohio Medicaid — visit benefits.ohio.gov.