Medicaid
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Ohio’s proposed Medicaid work requirement could cost thousands of Ohioans their healthcare coverage

Emily Campbell
Chief Executive Officer
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January 13, 2025
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Unless they qualify for an exemption, up to 450,000 Ohioans could be at risk of losing health coverage if Ohio’s proposed Medicaid work requirement waiver goes into effect. This estimate was calculated by The Center for Community Solutions based on the latest publicly available data on the employment status and health coverage of Ohioans. It far exceeds the fewer than 62,000 Ohioans who the Ohio Department of Medicaid (ODM) projects would lose coverage if the proposed waiver were implemented. The actual number of Ohioans who lose coverage will fall somewhere between those two figures.

Estimated impacts by county

Using the latest data on Medicaid enrollees on the ODM’s Annual Enrollment Dashboard and information contained in the proposed 1115 Waiver, Community Solutions produced estimates of the number of residents in each county who are likely to lose coverage in 2026 if the work requirement is implemented. 

The unique Medicaid recipients enrolled in calendar year 2023 in the Expansion caseload group between 19 and 64 was used to establish the spread of enrollees across Ohio’s 88 counties. ODM estimated that “in CY 2026 no more than 61,826 individuals will be considered not exempt and not currently working.” We assumed the impact is evenly felt across counties, dividing the 61,826 impacted individuals among counties using the 2023 county shares.

In 2023, Franklin County residents comprised 12.8 percent of Ohio’s total Expansion working age population.

For example: In 2023, Franklin County residents comprised 12.8 percent of Ohio’s total Expansion working age population. Using that share of the total, 12.8 percent of the statewide estimated impacted members would be 7,898. 

Many working-age Ohioans are at-risk for losing coverage

We also present the much larger estimates of working-age Ohioans at risk for losing coverage under this proposal, relying on the U.S. Census Bureau’s American Community Survey (ACS) 5-year estimates for 2023 which were released in December 2024. ACS provides self-reported data on health coverage and work status for the population ages 16-24 for each county. Community Solutions calculated the percent of working age residents in each county who said they had “Medicaid or other means tested coverage” for their health insurance and who did not work. We applied those percentages to the total number of working-age Expansion enrollees in 2023 to arrive at the number at risk.

The proposed waiver would impose work requirements on a narrower cohort of current Medicaid recipients than captured by the Census data. In particular, the Census counts people aged 16 and 17 and 55 to 64 who would be exempt from the proposed requirement. We have no way to accurately gauge the number of people in each county who would fall under the other vague exemption categories.

Pike County has the highest percent of the working-age population who is at risk.

Which counties will be most affected?

While the publicly available data does not line up with exemptions listed in the proposed Medicaid waiver, it indicates the counties whose residents may be most impacted by the proposed changes. Pike County has the highest percent of the working-age population who is at risk—15.9 percent—followed closely by Scioto at 15.2 percent. Eleven other counties are above 10 percent. Most of the counties with the highest share of at-risk working age adults have unemployment rates which are higher than the state average, suggesting that jobs may be more difficult to find in those communities.

Medicaid Work Requirement County Estimates
County Population Ages 16-64 LOSE COVERAGE (Based on ODM Estimates) AT RISK (Based on U.S. Census Bureau Data) Percent Working Age Population at Risk
Adams 15,293 194 1,857 12.1%
Allen 56,095 565 4,281 7.6%
Ashland 29,191 216 1,581 5.4%
Ashtabula 53,605 617 4,593 8.6%
Athens 40,172 337 2,972 7.4%
Auglaize 25,508 126 784 3.1%
Belmont 36,022 356 2,774 7.7%
Brown 24,678 250 2,153 8.7%
Butler 228,860 1,886 13,132 5.7%
Carroll 14,846 112 1,037 7.0%
Champaign 22,190 166 1,023 4.6%
Clark 75,458 967 7,278 9.6%
Clermont 122,211 772 6,215 5.1%
Clinton 24,038 219 1,451 6.0%
Columbiana 55,810 550 4,355 7.8%
Coshocton 20,226 206 1,409 7.0%
Crawford 23,393 244 1,638 7.0%
Cuyahoga 734,482 8,255 59,035 8.0%
Darke 28,150 200 1,321 4.7%
Defiance 21,442 161 1,210 5.6%
Delaware 129,022 379 2,638 2.0%
Erie 41,414 373 2,164 5.2%
Fairfield 91,966 706 5,099 5.5%
Fayette 16,449 162 1,631 9.9%
Franklin 822,999 7,898 52,084 6.3%
Fulton 24,080 141 867 3.6%
Gallia 16,071 197 1,686 10.5%
Geauga 51,844 193 1,187 2.3%
Greene 97,086 671 4,583 4.7%
Guernsey 21,562 246 1,585 7.4%
Hamilton 486,940 4,534 30,575 6.3%
Hancock 43,533 268 1,977 4.5%
Hardin 17,875 138 1,189 6.7%
Harrison 7,918 71 693 8.8%
Henry 15,294 89 491 3.2%
Highland 24,206 247 2,095 8.7%
Hocking 16,120 164 1,576 9.8%
Holmes 23,613 72 432 1.8%
Huron 32,897 279 1,866 5.7%
Jackson 18,786 214 1,875 10.0%
Jefferson 36,751 445 3,821 10.4%
Knox 35,340 251 1,835 5.2%
Lake 134,700 864 5,898 4.4%
Lawrence 33,217 441 4,122 12.4%
Licking 104,954 770 5,365 5.1%
Logan 26,286 191 1,501 5.7%
Lorain 177,540 1,481 12,088 6.8%
Lucas 249,484 2,708 19,255 7.7%
Madison 23,295 160 1,154 5.0%
Mahoning 126,092 1,631 11,331 9.0%
Marion 33,824 436 3,422 10.1%
Medina 105,375 527 3,302 3.1%
Meigs 12,529 151 1,433 11.4%
Mercer 22,696 108 856 3.8%
Miami 61,202 434 2,919 4.8%
Monroe 7,298 79 595 8.2%
Montgomery 306,131 3,394 24,166 7.9%
Morgan 7,672 74 623 8.1%
Morrow 20,370 149 1,017 5.0%
Muskingum 49,441 542 4,257 8.6%
Noble 5,595 60 593 10.6%
Ottawa 21,631 151 1,057 4.9%
Paulding 10,524 70 585 5.6%
Perry 20,359 209 1,752 8.6%
Pickaway 32,801 272 2,646 8.1%
Pike 15,305 220 2,432 15.9%
Portage 98,867 726 4,489 4.5%
Preble 23,014 186 1,482 6.4%
Putnam 18,770 73 531 2.8%
Richland 66,246 692 5,040 7.6%
Ross 41,793 519 4,759 11.4%
Sandusky 33,316 280 2,163 6.5%
Scioto 41,048 640 6,221 15.2%
Seneca 31,348 249 1,865 5.9%
Shelby 26,891 171 1,356 5.0%
Stark 211,823 1,965 14,652 6.9%
Summit 315,395 3,142 20,770 6.6%
Trumbull 111,068 1,279 11,133 10.0%
Tuscarawas 51,539 394 3,116 6.0%
Union 37,765 149 993 2.6%
Van 16,141 113 713 4.4%
Vinton 7,362 79 846 11.5%
Warren 140,066 566 4,523 3.2%
Washington 33,667 300 2,145 6.4%
Wayne 65,124 445 3,046 4.7%
Williams 20,323 159 996 4.9%
Wood 80,546 360 2,276 2.8%
Wyandot 12,072 83 643 5.3%
STATEWIDE 6,815,941 61,826 448,173 6.6%
Made with HTML Tables

Ohio’s working-age uninsured rate would nearly double with proposed changes

Ohioans denied Medicaid coverage due to work requirements will almost certainly become or remain uninsured. Since they are not working, they would have no access to employer sponsored coverage and have household incomes too low to qualify for premium subsidies through the Marketplace.

If all the at-risk residents are denied coverage, Ohio’s working-age uninsured rate would climb from the current rate of 8.8 percent to 15.3 percent—levels not seen since the early 2010s. Eighteen counties, most of which are small and rural, could see uninsured rates over 20 percent as a result. Being uninsured has been linked to lost productivity, lower wages, and higher employee turnover.

This is the exact opposite of the proposed waiver’s intended impact.

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Medicaid in Ohio by County

More than 25 percent of Ohio's population receives health care coverage from Medicaid. These fact sheets explore those covered populations, work requirements, and the potential for coverage loss if policy or funding changes are made to the program. Data released 2025.

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