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Elimination of Medicaid Expansion Could Mean Loss of Coverage for 700,000+ Ohioans

A report recently released by the Kaiser Family Foundation (KFF) finds that a proposal currently under consideration by Congress as part of budget negotiations to cut the Affordable Care Act’s (ACA) Medicaid expansion rate could cause 20 million people to lose Medicaid coverage nationwide. In Ohio, KFF estimates that would mean a 23% decline, or 727,000 fewer people enrolled in Medicaid.

About the ACA Expansion

The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, which is $44,367 for a family of four in 2025, but a U.S. Supreme Court ruling effectively made the decision to implement the expansion optional for states. Ohio is one of 41 states, including the District of Columbia, to have adopted Medicaid expansion.

Currently, the federal government pays 90% of the costs for expansion enrollees. For non-expansion, or traditional, Medicaid enrollees, the federal government pays from 50% to 70%, depending on the state’s per capita income relative to the national average. In Ohio in 2025, the federal government pays 64.6%.

KFF Analysis

KFF’s analysis contains state-by-state estimates for two scenarios if, beginning in 2026, Congress reduces the federal match from 90% to either 70% or 50% for the costs of covering individuals under Medicaid expansion.

The first scenario assumes that all states would maintain their Medicaid expansion by replacing lost federal funding with increased state funding, and no enrollees would lose coverage. This would result in a decrease in federal Medicaid spending of 10%, or $626 billion, across all states during a 10-year period.

The second scenario assumes states would not recoup the funding shortfall from federal cuts and drop Medicaid expansion, resulting in a $1.7 trillion decrease in federal Medicaid spending and a $186 billion decrease in state Medicaid spending across all states over a 10-year period.

If states were to maintain their Medicaid expansion coverage in the wake of a federal policy change, they would need to find ways to offset the loss of federal funding. Increasing tax revenues or reducing coverage or provider reimbursement rates are the likely options.

Trigger Laws & State Budget

Nationally, 12 states have trigger laws in place that would automatically end expansion or require changes if the federal match rate were to drop. Not all trigger laws would immediately end the Medicaid expansion, but enrollees in states with such laws are at greater risk of losing coverage. While Ohio does not currently have a trigger law, the governor’s budget proposal includes language that could end expansion in the state if any change is made to the 90% federal match.

A related provision of the governor’s budget would implement work requirements for Medicaid recipients. The proposal, which require a federal waiver, would apply to the Medicaid expansion population and stipulate that Medicaid enrollees must work unless they are over age 55, enrolled in school or an occupational training program, participating in an alcohol and drug addiction treatment program, or have intensive healthcare needs or serious 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 is in the midst of developing its biennial budget. Gov. Mike DeWine released his proposal on Feb. 3. The Ohio General Assembly is required to have a budget finalized and in place when the new state fiscal year begins on July 1.

For more on the KFF analysis, view the full report. Read about The Center for Health Affairs’ 2025 policy priorities, including those related to the Medicaid program, here and for a deeper understanding of the state Medicaid program, read this primer from the Health Policy Institute of Ohio.