On February 16, Ohio Medicaid announced it will seek federal approval to implement a work requirement for Medicaid expansion enrollees on Sunday, July 1, that is based on provisions of House Bill (HB) 49 and the Centers for Medicare and Medicaid Services (CMS) guidelines issued on January 11. The stated purpose of the waiver is to promote financial independence, community engagement, and better health outcomes among Medicaid expansion enrollees.
The American Academy of Family Physicians has warned Health and Human Services (HHS) and states, like Ohio, who seek the flexibility to change their Medicaid programs should be careful to not harm patients by reducing access or erecting unnecessary barriers to care.
The fiscal year 2018-19 operating budget (HB 49) requires Ohio Medicaid to seek federal approval to require Medicaid enrollees in the expansion group to work unless they are over age 55, enrolled in school or occupational training, participating in an alcohol or drug addiction treatment program, or have intensive physical health care needs or serious mental illness (RC 5166.37).
Most of the 700,000 Ohioans enrolled in the Medicaid expansion work – 58% earned income in the previous year and 44% currently meet the work requirement. Additional enrollees are exempt from the requirement based on Ohio law and new federal guidelines. As a result, an estimated 95% of the current Medicaid expansion population will meet the work requirement or be exempt, and the remaining 5%– about 36,000 individuals – will need to seek work or otherwise comply with the requirement to remain enrolled in Medicaid.
To comply with the work requirement, Medicaid expansion enrollees will need to demonstrate they work at least 20 hours a week or are engaged in other allowable activities, including job search, education and training, or unpaid work in certain cases. New enrollees must meet the requirement when they enroll, and current enrollees must meet the requirement during their annual eligibility renewal. Failure to meet the requirement results in termination of Medicaid benefits. Limited exceptions may be granted, for example for a family emergency or illness.
Ohio Medicaid posted the proposed work requirement online for public comment through Sunday, March 18. The Ohio Academy of Family Physicians will be submitting comments for consideration. Public hearings were held in Cincinnati on February 21 and will be held in Columbus, OH, on Thursday, March 1. Based on input from the hearings and public comments, Ohio Medicaid will finalize the application and submit to CMS for review. CMS will post Ohio’s waiver application online for at least 30 days and then wait at least 45 days after submission before making a decision.