Medicaid expansion in Ohio has significantly broadened access to healthcare for many residents. Understanding the eligibility requirements and application process is crucial for social workers assisting clients in need.
Overview of Medicaid Expansion in Ohio
In January 2014, Ohio expanded Medicaid under the Affordable Care Act, extending coverage to adults aged 19 to 64 with incomes up to 138% of the federal poverty level (FPL). This expansion aimed to reduce the uninsured rate and improve health outcomes across the state.
Eligibility Requirements
As of January 2026, Ohio’s Medicaid expansion eligibility includes:
- Age and Income: Adults aged 19 to 64 with incomes up to 138% of the FPL.
- Citizenship and Residency: Applicants must be U.S. citizens or legal residents and Ohio residents.
- Not Eligible for Other Medicaid Groups: Individuals eligible for other Medicaid categories, such as those with disabilities or pregnant women, are not included in the expansion group.
- Age: Be at least 55 years old.
- Employment: Be employed.
- Education or Training: Be enrolled in school or an occupational training program.
- Substance Use Treatment: Be participating in an alcohol and drug addiction treatment program.
- Health Conditions: Have intensive physical health care needs or serious mental illness.
- Online: Visit the Medicaid Consumer Hotline website.
- Phone: Call the Medicaid Consumer Hotline at 800-324-8680 (TTY: 711), Monday – Friday, 7 a.m. – 8 p.m., and Saturday, 8 a.m. – 5 p.m., Eastern time.
- In Person: Go to your County Department of Job and Family Services.
- Assessment: Evaluate clients to determine if they meet the new criteria set forth in HB 33.
- Guidance: Provide information on the application process and necessary documentation.
- Advocacy: Support clients in navigating potential challenges related to the new eligibility requirements.
- Medicaid Expansion: Extended coverage to adults aged 19 to 64 with incomes up to 138% of the FPL.
- Additional Eligibility Criteria: Introduced in HB 33, requiring individuals to meet at least one of five specified conditions.
- Application Methods: Available online, by phone, or in person at county departments.
- Ohio Revised Code Section 5166.37, 2023/https://codes.ohio.gov/ohio-revised-code/section-5166.37
- Ohio Department of Medicaid, 2025/https://content.govdelivery.com/accounts/OHIOGOVERNOR/bulletins/3d4b0fb
- Humana Healthy Horizons, 2025/https://www.humana.com/medicaid/ohio/support/application-requirements
- Ohio Department of Medicaid, 2025/https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Home/1115_Work_Requirements_JMOC_2025.pdf
- Urban Institute, 2025/https://www.urban.org/research/publication/public-comment-medicaid-work-requirements-ohios-section-1115-demonstration
- Ohio Academy of Family Physicians, 2025/https://www.ohioafp.org/wfmu-article/ohio-medicaid-files-medicaid-waiver-to-include-work-requirements/
In July 2023, the Ohio General Assembly enacted House Bill 33 (HB 33), introducing additional eligibility criteria for the adult Medicaid expansion population. According to Ohio Revised Code Section 5166.37, individuals must meet at least one of the following to qualify:
The Ohio Department of Medicaid (ODM) is seeking approval from the Centers for Medicare & Medicaid Services (CMS) to implement these requirements, with plans to submit a waiver application between February 1 and March 1, 2025. (medicaid.gov)
Application Process
To apply for Medicaid in Ohio:
After applying, applicants will receive a notice regarding their eligibility. If eligible, they will be enrolled in a managed care plan. During the initial enrollment period, individuals can switch plans without restrictions. After this period, they will remain enrolled in their chosen plan as long as they remain eligible for Medicaid. (humana.com)
Implications for Social Workers
Social workers play a vital role in assisting clients with Medicaid enrollment and understanding the new eligibility requirements. Key considerations include:
Conclusion
Ohio’s Medicaid expansion has been instrumental in providing healthcare access to a broader population. With the introduction of additional eligibility criteria under HB 33, it is essential for social workers to stay informed and assist clients effectively through the application process.