health care providers like Rocking Horse Community Health Center CEO Dr. Yamini Teegala are concerned that inability to always meet work or alternative requirements and the new redetermination process could increase gaps in care.
“My concern is this decision is being made because of hindsight but with no foresight,” Teegala said.
While the changes are estimated to save the federal government nearly $1 trillion over the next 10 years, Teegala said this does not account for increased health care spending in response to patients losing access to care and could end up costing more in the long run.
She said in all, there will be a greater administrative burden, and work can be difficult to sustain with challenges obtaining transportation and cost-prohibitive childcare.
Who has Medicaid?
More than one in four Ohioans receive Medicaid.
In Clark County, 47,757 residents (36% of the population) have health coverage through Medicaid, according to the most recent data from the Clark County Department of Job and Family Services. Of those people, 24,595 are aged 19 to 44.
Earlier data show just less than 7,000 are aged 5 or younger, 12,960 are aged 6 to 18, 8,398 are 45 to 64 and 3,590 are 65 or older — part of the Medicaid Expansion program.
Medicaid covers three in five children 18 and younger, three in 10 working age adults and one in 10 older adults.
The uninsured rate in Ohio is now half of what it was before Medicaid expansion, going from 12.3% to 6.1%, according to census data.
Ohio expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level under the Affordable Care Act.
According to the Health Policy Institute of Ohio, this expansion has improved access to and use of health care, increased affordable care, led to improvements in some health outcomes, lowered mortality rates and improved financial wellbeing. States and providers accepting Medicaid have seen increased revenue, fewer hospital closures, improved payer mixes (the percentage of patients covered by different payers) and lower uncompensated care costs.
To qualify for Medicaid, a family must be at the federal poverty level ($32,150 for a family of four) and meet other qualifying conditions. Medicaid expansion boosts eligibility to up to 138% of the federal poverty level ($44,367 for a family of four).
About 60% of Rocking Horse’s patients are covered by Medicaid, which translates to about 8,500 people, Teegala said. The health center saw about 15,700 patients last year.
Credit: Jessica Orozco
Credit: Jessica Orozco
For patients with Medicaid coverage, Rocking Horse is subject to a Prospective Payment System (PPS), which is a method of reimbursement based on a fixed, predetermined amount. It may then receive supplemental payments to bridge any gaps.
What changes are coming?
Ohio’s 2026 and 2027 budget, signed earlier this month by Gov. Mike DeWine, includes language that could cancel Medicaid coverage for about 770,000 Ohioans. The bill specifies that if federal lawmakers cut funding for Medicaid expansion, the state will back out of the program.
The federal spending plan, dubbed the One Big Beautiful Bill Act, eliminates the two-year, 5% increase in federal matching funds for states effective December 2026. It also requires all states to redetermine eligibility for those with Medicaid under the expansion every six months instead of every 12 months.
Starting October 2028, it will require states to impose cost sharing requirements for those under the expansion whose income is just above the federal poverty level, up to $35 per service and no more than 5% of their income. Primary care, mental health and substance use disorder treatment, family planning, institutional long-term care and emergency care at a hospital emergency department will be exempt.
Retroactive coverage in Medicaid will be limited from three months for everyone to one month for those under the expansion and two months for traditional enrollees.
Able-bodied Medicaid recipients between the ages of 19-64 and those part of the expansion group will be required to work at least 80 hours per month, perform at least 80 hours of community service or a work program, enroll part-time in an educational program or perform at least 80 combined hours of qualifying activities.
Because the federal reconciliation bill bars health care providers that offer abortion services from participating in the Medicaid program, Planned Parenthood’s Springfield and Hamilton locations will close Aug. 1.
How will work requirements, redetermination changes impact Clark County residents?
Transportation and child care are significant barriers to individuals and families in Clark County seeking jobs, Clark County Department of Job and Family Services Director Ginny Martycz said. Child care is often “cost prohibitive for those who need it most.”
“As is the case with all of the program requirements, it will be imperative for people to have their current contact information on file with the agency,” Martycz said. “Also, read materials they receive. Work at getting at least the 80 hours a month work requirement now. Don’t wait.”
Of the 24,595 Clark County individuals between ages 19-64 on Medicaid, 5,721 reported some type of disability and 8,741 have employment listed that does not include a zero income or no income entry, according to DJFS. Employment with zero income means someone is employed but is not getting hours and therefore is not being paid.
“At this stage with what facts we know,” about 10,000 individuals will be impacted by new work requirements, said Tammi Hively, program administrator of BenefitsPlus at DJFS.
This can change based on the finalized rules and implementation date, Martycz said.
With work requirements planned to take effect Dec. 31. 2026, the Health and Human Services Secretary will issue guidance to the states by June 1 next year, Martycz said. It is “difficult to project into the future” but this guidance will give DJFS a better idea of the impact.
States may be able to delay implementation of the new requirements through Dec. 1, 2028, Martycz said.
Government assistance programs like Medicaid have always aimed “to provide a hand up during difficult times,” Martycz said. She said those able to work or meet other requirements “can take pride in what they accomplish.”
Changes to the work requirements have been long discussed, Martycz said.
“They are not all that different from some of the requirements of Welfare Reform in the 1990s,” she said. “The goal will be to enact changes that are really meaningful and enhance the ability of our residents to live a quality life.”
As far as health outcomes in Clark County, Rocking Horse’s Teegala is concerned. The county was “about to make some progress” in reducing the burden of chronic disease by investing in social determinants of health and community health workers, but now she’s concerned the county is going to regress.
“I really think the key now is to come up with strategies on how we can sustain the huge administrative burden as well as financial impact ... and poor health outcomes, because there will be gaps (in care),” Teegala said.
Credit: Bill Lackey
Credit: Bill Lackey
Patients with chronic diseases like diabetes that see gaps in care are at risk of losing control of their conditions, Teegala said. This could lead to increased morbidity and more health care spending in the long run, she said.
Teegala believes the new work requirements and semi-annual redeterminations could cause some people to lose access to Medicaid, but she said “just because they couldn’t get into Medicaid doesn’t mean that they can afford marketplace” insurance.
“I do believe that uncompensated care or uninsured patient care will increase in places just like Rocking Horse, and that is not sustainable, because we know when somebody becomes completely uninsured, Rocking Horse tries to administer a sliding fee scale system,” Teegala said. “We don’t usually turn away anybody, so that means we will be writing off a lot of care that we are providing and I don’t know if that is sustainable in the long run.”
The majority of Rocking Horse’s patients who are in the country under Temporary Protected Status have started the process to gain another form of status, Teegala said. If they get another legal status before the upcoming end of TPS, they may still be eligible for Medicaid coverage.
Rocking Horse is also concerned about future cuts in the pipeline for the federal government to meet the savings goals Trump and his supporters have shared.
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