The federal government has withdrawn its approval for Ohio Medicaid to create the program's first ever work requirements.
The decision is the latest update in a more than five year effort by conservative lawmakers to require those covered through Medicaid expansion to document they either have a job, are in school or have an exemption.
Two years ago, the U.S. Centers for Medicare and Medicaid Services under the Trump administration approved Ohio's request to make the changes, which hadn't been implemented due to the ongoing pandemic. This week, the Biden administration withdrew support for the requirements.
Ohio Gov. Mike DeWine on Wednesday called the decision "extremely disappointing."
"Ohio's reasonable approach provided individuals with options while supporting them on their way to self-sufficiency," DeWine said. "The Biden Administration's decision was short-sited and contrary to our statewide effort to improve public health."
About 3.2 million Ohioans are covered by the joint state-federal insurance program, including just under 800,000 covered by the expansion of the program under the Affordable Care Act.
This includes around 43,200 people in Montgomery County, 24,300 in Butler County, 11,000 in Clark County, 8,400 in Greene County and 7,000 in Warren County covered by the expansion of Medicaid eligibility as of June, which is the latest state Medicaid data available.
Work requirements have been hailed by some conservative lawmakers as a way to encourage self sufficiency and has been years in the making.
Ohio Medicaid had requested federal permission to create work requirements under the direction of the Republican-majority Ohio General Assembly during former Gov. John Kasich's administration.
At the same time, courts have struck down other requirements, and some studies have shown the work requirements lead to people falling off the rolls because they don't know about the paperwork requirements or don't keep up with the forms correctly.
"There's no evidence that work requirements do anything other than disenroll people," said Loren Anthes, who researches Ohio Medicaid for Cleveland-based Center for Community Solutions.
Anthes said studies since Medicaid was expanded have demonstrated that it's a key tool in fighting against addiction and infant mortality, and that it helps rural providers stay open.
When submitting the original application, state officials had estimated that about 95% of those covered by the expansion would already either meet the work requirement or be exempt. Some of the exemptions include being age 50 or older, participating in drug or alcohol treatment, being pregnant, or complying with work requirements associated with other programs like SNAP, also known as food stamps.
The Biden administration, however, estimated between 121,000 and 163,000 beneficiaries could lose coverage in the first 12 months of implementation, based on what happened with Arkansas work requirements and with Ohio adding work requirements for SNAP.
The administration noted that people could lose coverage because of documentation errors or lack of awareness.
Additionally, the administration highlighted Ohio's problems with the computer system used to determine eligibility. State audits have found serious issues with the system and with backlog, including one report indicating that the error rate for determining Medicaid eligibility in the state was 43%, more than double the national average.
"Thus, the introduction of an administratively complex program like the community engagement requirement presents a serious risk of beneficiary disenrollment due to technical errors," the administration stated in a letter withdrawing support for work requirements.
Republican Ohio Sen. Rob Portman expressed disappointment at the decision, saying the requirements would have "provided greater well-being and self-sufficiency to individuals who are able to work."
Democratic Ohio Sen. Sherrod Brown commended the move. "We should be making it easier for Ohioans to access care, not harder — especially at a time when Ohioans are fighting against the COVID-19 global pandemic," Brown said.
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