Medicaid changes floated on Ohio and federal level could impact hundreds of thousands

Hundreds of thousands of Ohio children are enrolled in public health insurance such as Medicaid, which could be in for major changes and cuts as the new presidential administration takes hold with authors and proponents of Project 2025 nominated for key roles.

Meanwhile, the state of Ohio faces a new two-year budget cycle in 2025, where lawmakers and the governor will, among many other things, deal with Medicaid, any potential federal-level cuts, and financing for new child well-being laws passed just before the new year.

The federal Medicaid program includes the Children’s Health Insurance Program (CHIP), and nationally covers 79.4 million Americans, targeting largely those in low income brackets or with disabilities. Data from the Health Policy Institute of Ohio showed more than 700,000 Ohio children between ages 6 and 18 had Medicaid as of the 2022-2023 school year.

More than a decade ago, the federal government allowed flexibility for school-based health services for those students who were covered by Medicaid, something the HPIO recommended for expansion in the state to help student health outcomes and well-being.

“Children from families with low incomes, and therefore eligible for Medicaid often experience more barriers to accessing health care due to factors such as lack of transportation or parent challenges taking time off work,” according to an HPIO report on school-based health care and Medicaid released in December.

The state’s Medicaid School Program also utilizes Medicaid reimbursement to allow schools to provide “school-based therapy services” to students on Medicaid as part of the students’ individualized education plan (IEP).

Source: Health Policy Institute of Ohio

The county with the highest student enrollment rate in Ohio was Hocking County with 53.7%. It was one of 22 counties with child enrollment rates between 42.6% and 53.7%, the highest range in the state. Another 22 counties have enrollment between 34.8% and 42.1%, and 22 have rates between 27.9% and 34.6%, according to the HPIO. Delaware County had the lowest rate of enrollment in the state at 9.9%.

But a new Republican majority in the U.S. House and changing of hands at the presidential level could mean less funding for the Medicaid program, and impact programs at the state level.

The rumblings of changes to health care in American started with the Project 2025 document from the conservative Heritage Foundation, authors and proponents of which have been nominated for roles within the Trump administration. The Center on Budget and Policy Priorities found that the Project 2025 plans, along with a Republican study committee and U.S. House Budget Committee plans could lead to a rise in uninsured Americans and health care costs in general.

Plans have been publicly revealed that would cut funding and change regulations for Medicaid, including rolling back an Affordable Care Act expansion, as well as a shift to block grants and another attempt at adding work requirements to adult Medicaid eligibility, something Ohioans have seen pop up in state-level discussions of the program as recently as Dec. 17.

With Ohio’s biennial state operating budget up for approval this year, it’s as yet unclear how these developments might impact the funding requests in Gov. Mike DeWine’s executive budget proposal when it comes to child wellbeing, or how the state will brace for impacts should the Medicaid funding cuts come down from the federal level.

One law in particular that is hoping to receive funding in the next state budget could be impacted by Medicaid decisions. House Bill 7 was passed at the end of the year, though it was passed without the funding originally written into the bill.

The new law targets various programs and aspects of state oversight when it comes to child development, parenting, and infant and maternal mortality.

Despite no new funding coming with the law as of yet, H.B. 7 was passed with provisions directing the Ohio Department of Medicaid to conduct a study on the reimbursement of “evidence-based peer-to-peer programming that supports infant vitality,” among other aims of the law.

When the law was still in the Ohio Senate Finance Committee, the Ohio Psychological Association praised the bipartisan bill sponsors for including a provision that would require the Ohio Department of Medicaid to look at reimbursement “pathways” for youth mental health.

The law would also require the director of the ODM to develop “policy and billing guidance” for providers on Medicaid coverage. It also requires the director to submit a report to the governor and the General Assembly laying out stakeholder engagement regarding ODM procedures on early childhood mental health services coverage and accounting for the number of families and children served, along with the services and outcomes from the programs, according to the Legislative Service Commission analysis of the bill.