The Biden Administration has withdrawn Ohio’s 1115 work requirement waiver.
In the summer of 2017, the Ohio General Assembly enacted House Bill 49, requiring a new eligibility condition for the adult Medicaid expansion population (Group VIII). The legislature wanted to require all new adult group beneficiaries, ages 19 through 49, with certain exemptions, to participate in and timely report 80 hours per month of qualifying community engagement activities, such as employment, education, or job skills training, as a condition of continued Medicaid eligibility. Those who failed to report would lose their Medicaid eligibility.
Ohio Medicaid applied for and received permission from the Trump Administration to impose this work reporting requirement on the expansion population. While there were many exceptions to who had to meet the requirements, Ohio Medicaid estimated that 50% of those who didn’t currently meet the requirements would lose coverage. Others estimated that the losses in coverage would be many times larger.
On August 10, 2021, the Centers for Medicare and Medicaid Services (CMS) found that this loss in coverage, as well as the likelihood that those exempt might also lose coverage, required withdrawal of the waiver. From the CMS letter to the Ohio Department of Medicaid, “community engagement requirements can cause beneficiaries to lose coverage not only where beneficiaries do not satisfy the required hours of participation or qualify for an exemption, but also because they are not aware of the requirements, do not understand reporting requirements, or are otherwise unable to complete timely reporting, including for qualifying exemptions and good cause exceptions.”
The DeWine administration had suggested that the waiver was the way to get people into jobs and self-sufficient. Instead, CMS found that the proposed waiver did not fulfill the purpose of the Medicaid program, “to furnish…medical assistance” to individuals “whose income and resources are insufficient to meet the costs of necessary medical services.”
The Ohio Academy of Family Physicians had expressed concern with the Medicaid work requirement fearing that the requirement was a barrier that would make it more difficult for people to access needed health care.