YOUNGSTOWN, Ohio – Proposed federal changes to Medicaid could harm more than a fifth of the residents in the congressional districts covering the Mahoning Valley, a brief by Policy Matters Ohio forecasts.
The brief, issued Thursday by the nonprofit policy research institute, outlines the potential effects of changes being considered that could push Ohioans out of the program.
“Congress is preparing a bill that will require the House Energy and Commerce Committee to cut $880 billion dollars from its budget,” said Kathryn Poe, Policy Matters researcher and author of the brief. “That virtually guarantees large cuts to Medicaid funding, which will strip coverage from Ohioans who need it and weaken our economy, over 4% of which is supported by Medicaid.”
Medicaid covers more than 3.2 million Ohioans, including 1.3 million children, according to the brief. In Ohio’s small towns and rural areas, 29.5% of children are covered by Medicaid or the Children’s Health Insurance Program.
In the 6th Congressional District, which includes Mahoning and Columbiana counties, 212,505 residents – 28% of the district’s population – were enrolled in Medicaid or CHIP as of October 2024. Of those enrolled, 37% are under age 19, 53% are between ages 19 and 64 and 10% are over age 64.
The 14th Congressional District, which includes Trumbull County, has 176,451 residents – 23% of the district’s population – enrolled in Medicaid or CHIP as of October 2024. Of those enrolled, 39% are under age 19, 50% are between the ages of 19 and 64 and 10% are 64 or older.
In Ohio, the federal government contributes $1.84 to Medicaid for every $1 the state invests, and 69% of federal funding sent to Ohio is for Medicaid, about $27.1 billion annually, Policy Matters Ohio reported in the brief.
The proposals include a national work requirement on working-age adults without children, spending caps, restrictions on states’ ability to tax health care providers and rate cuts for Medicaid Expansion, which in Ohio would trigger language in Gov. Mike DeWine’s plan to eliminate the program completely.
A recent list of spending cuts circulated among House Republicans suggested that a work requirement would slash $120 billion from Medicaid. According to the brief, Ohio has proposed its own state-level work requirement, similar to those implemented in Georgia, New Hampshire and Arkansas, all of which resulted in major coverage losses. By the Ohio Department of Medicaid’s own estimates, Ohio’s proposal would threaten more than 60,000 Ohio adults with the loss of coverage.
The federal government currently pays a fixed share of Ohio’s Medicaid costs based on actual costs incurred by the program, but two proposals are being considered to change the funding formula.
Under a per-capita cap, the federal government would instead pay states no more than a fixed amount of funding per enrollee, leaving states responsible for all remaining costs. Under an overall cap, as with Block Grant programs, Ohio would receive a fixed dollar amount that wouldn’t adjust for enrollment changes.
“Some legislators would prefer to target individuals with lifetime spending caps, cutting off Medicaid coverage when the cost of a person’s medical care reaches an arbitrary limit, regardless of their financial situation,” according to the brief. Estimates vary depending on the cap being proposed, but a 2021 estimate from the Center for American Progress projects that lifetime caps could impact 614,300 Ohioans.
Ohio would have exceeded the modeled per-capita cap in four eligibility categories from 2019 to 2022. Ohio would have lost $190 million in federal funding in 2019. In 2022, Ohio would have lost nearly $2 billion in federal funding, or 26% of state-funded Medicaid benefit spending.
The federal government covers 90% of the overall costs of care for Ohioans in Group VIII: people covered under Medicaid Expansion. This group primarily covers low-income working adults and very low-income adults from ages 19 to 64. Lowering the Federal Medical Assistance Percentage rate would require states to either cover the gap or eliminate the group entirely.
One analysis found that a proposal to cut the Medicaid Expansion FMAP could reduce total Medicaid spending by up to $1.9 trillion over a 10-year period, causing 20 million people to lose Medicaid coverage. In Ohio, any FMAP reduction would result in coverage losses for 700,000 Ohioans due to proposed trigger language in the governor’s state budget that would eliminate coverage for the group immediately should the FMAP decrease by even 1%, resulting in 23% of Ohioans who currently access health care through Medicaid losing coverage.
Elimination of the ability to tax health care providers – which generates revenue that states use to pay for their share of Medicaid spending and draw down additional federal funding – would cost Ohio billions of dollars in health care funding. The governor’s proposed budget recommended increasing the tax from 4.5% to 7%.
“People from all over the state will be harmed by federal cuts,” Poe said. “These district-specific numbers should make clear to every member of Ohio’s congressional delegation that the folks back home need them to resist and reject Medicaid cuts in any form.”