Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Ohio

Medicaid work requirements in Ohio: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Ohio expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 659,491 of them (9.6% of an expansion pool of 705,005) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 224,631 people in Ohio lose coverage by 2034: 204,847 of them still eligible but lost to paperwork and reporting failures, and 19,785 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Ohio scores 73 of 100 on this model's ex parte capability index, a low band; its eligibility system is OBIE / Ohio Benefits.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureOhio
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)705,005
Adults subject, strict definition659,491
Adults subject, permissive definition646,301
Share of expansion pool subject9.6%
Projected coverage loss by 2034224,631
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)73 (low)

Who is subject in Ohio

Of the 659,491 subject adults, 37% already work 80 or more hours a month and 56% are not working. 27% have a child under 14 at home. Among those not working, 54% report a disability and 11% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2414%
Age 25-3420%
Age 35-4418%
Age 45-5419%
Age 55-6428%
Not working56%
1 to 19 hours a month1%
20 to 79 hours a month6%
80 or more hours a month (meets the bar)37%
Not working: Disabled54%
Not working: Caregiver11%
Not working: Postpartum0%
Not working: Student2%
Not working: Other33%

Why eligible people lose coverage

Of the 224,631 projected to lose coverage in Ohio, 204,847 meet the requirement or qualify for an exemption but fail to document it. 98,415 of those are working people who cannot prove their hours through data the state can see, and 106,432 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work27,326
Multiple part-time jobs (aggregation failure)20,361
Self-employed (other)19,659
Cash-paid construction & trades8,236
Volunteering / job training7,297
Full-time students not auto-verified7,274
Seasonal: agriculture, hospitality, food service5,741
Gig / courier (DoorDash, Uber, Lyft, Instacart)2,520
Medically frail without auto-match45,071
Caregivers of a disabled adult32,109
American Indian / Alaska Native (tribal exemption)8,213
Kinship caregivers (non-parent) of children ≤136,154
SUD treatment not flagged in claims data5,338
Parent caregivers of children ≤13 without auto-match4,798
Recent incarceration (data-match gap)2,418
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)2,043
Pregnancy / postpartum data lag287

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (80% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Ohio's composite score is 73 (low band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite73
Observed ex parte80
Core capability78
Data sources72
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four257,91839.1%
Working ≥ qualifying hours / income140,85721.4%
Medically frail114,89617.4%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1367,11310.2%
Parent caregiver of child ≤1320,6733.1%
Full-time student17,5622.7%
Working ≥ qualifying hours / income + Full-time student15,7362.4%
Working ≥ qualifying hours / income + Medically frail12,1861.8%

Counties in Ohio

Subject adults concentrate: Cuyahoga County (67,349), Franklin County (66,479), and Hamilton County (44,830) account for 27% of the state's subject population.

All 88 counties in Ohio with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Cuyahoga County67,3499.2%22,94016.0%734,121
Franklin County66,4798.0%22,64315.0%830,596
Hamilton County44,8309.1%15,27015.0%490,344
Summit County29,7469.4%10,13212.0%316,228
Montgomery County29,1429.4%9,92615.0%311,097
Lucas County23,3739.4%7,96118.0%249,453
Butler County23,0739.9%7,85912.0%232,064
Stark County21,44510.1%7,30513.0%212,282
Lorain County18,18410.0%6,19413.0%182,096
Warren County13,7339.3%4,6785.0%148,232
Lake County13,64010.1%4,6468.0%134,608
Mahoning County12,97410.2%4,41918.0%127,212
Delaware County12,3589.3%4,2095.0%133,576
Clermont County11,7729.5%4,0108.0%123,390
Trumbull County11,42810.1%3,89317.0%112,682
Medina County10,80810.2%3,6816.0%106,198
Portage County10,40710.5%3,54511.0%99,434
Licking County10,2429.7%3,48910.0%106,141
Greene County9,8629.9%3,35911.0%100,014
Fairfield County8,8829.3%3,0259.0%95,504
Wood County8,44810.5%2,87813.0%80,292
Clark County7,71010.2%2,62616.0%75,694
Wayne County7,14211.1%2,4339.0%64,638
Richland County6,8439.6%2,33114.0%71,328
Miami County6,32410.1%2,1548.0%62,547
Geauga County6,06311.7%2,0656.0%51,930
Columbiana County5,89410.3%2,00813.0%57,282
Allen County5,85310.3%1,99412.0%56,821
Ashtabula County5,55810.1%1,89318.0%55,222
Tuscarawas County5,47710.7%1,86512.0%51,374
Muskingum County4,8569.8%1,65416.0%49,796
Athens County4,49311.2%1,53024.0%40,204
Erie County4,42410.6%1,50711.0%41,612
Hancock County4,2579.8%1,45011.0%43,556
Jefferson County3,91610.7%1,33418.0%36,578
Scioto County3,9089.2%1,33124.0%42,330
Ross County3,8898.5%1,32516.0%45,932
Belmont County3,87010.2%1,31814.0%38,060
Knox County3,81810.8%1,30013.0%35,474
Washington County3,58210.7%1,22014.0%33,371
Sandusky County3,44710.3%1,17413.0%33,642
Seneca County3,39310.8%1,15612.0%31,485
Marion County3,3828.8%1,15216.0%38,328
Union County3,3538.1%1,1425.0%41,420
Huron County3,34810.1%1,14011.0%33,026
Pickaway County3,1718.7%1,08012.0%36,540
Ashland County3,12810.7%1,06512.0%29,298
Lawrence County3,0309.1%1,03218.0%33,148
Darke County2,99310.6%1,01911.0%28,299
Shelby County2,80610.4%95611.0%26,998
Auglaize County2,77410.9%9457.0%25,530
Logan County2,71310.4%92411.0%26,194
Ottawa County2,59012.0%8829.0%21,564
Fulton County2,50610.5%8548.0%23,792
Mercer County2,50010.9%8526.0%22,998
Holmes County2,49710.4%8519.0%23,966
Preble County2,46410.7%83910.0%22,978
Clinton County2,45410.2%83614.0%24,070
Highland County2,43610.0%83015.0%24,304
Brown County2,4309.7%82816.0%25,030
Crawford County2,2939.8%78114.0%23,344
Champaign County2,28010.2%7779.0%22,362
Defiance County2,26110.5%77011.0%21,428
Madison County2,2328.0%76010.0%27,846
Guernsey County2,20710.2%75217.0%21,739
Coshocton County2,09510.3%71419.0%20,261
Morrow County2,05210.0%69911.0%20,512
Perry County2,05110.1%69915.0%20,344
Williams County2,0479.8%69711.0%20,873
Putnam County2,04310.9%6967.0%18,716
Hardin County1,97511.1%67318.0%17,810
Jackson County1,8179.7%61917.0%18,671
Van Wert County1,70510.6%5818.0%16,140
Hocking County1,62910.2%55517.0%15,943
Carroll County1,62510.9%55412.0%14,941
Gallia County1,62510.1%55417.0%16,092
Fayette County1,5999.6%54516.0%16,654
Henry County1,58910.3%54110.0%15,362
Adams County1,54310.0%52620.0%15,375
Pike County1,4929.8%50820.0%15,268
Meigs County1,2449.9%42420.0%12,526
Wyandot County1,21710.1%4157.0%12,036
Paulding County1,09510.4%3739.0%10,516
Noble County1,04914.4%35717.0%7,290
Harrison County89311.3%30415.0%7,904
Morgan County84211.1%28717.0%7,596
Monroe County83211.4%28314.0%7,278
Vinton County6859.3%23319.0%7,388

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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