Gov. Mike DeWine has included language in his state budget bill that could immediately end Medicaid expansion in Ohio and cause hundreds of thousands of people to lose their health insurance coverage if the federal government reduces its share of paying for the program’s costs.
DeWine’s 4,000-plus page budget bill includes a clause that would “immediately discontinue all medical assistance” for people covered under Medicaid expansion if the federal government decides to pay less than the 90% of the share it currently offers for covering this group.
This wording is referred to as a “trigger law,” and it comes as congressional Republicans in Washington, D.C., consider cutting the federal match for Medicaid expansion. This is among other potential cuts to Medicaid and other programs that Republicans are considering as a way to pay for President Donald Trump’s agenda.
The trigger clause hasn’t yet made it into Ohio law. The state budget bill is being negotiated and is expected to be passed by the end of June. Broad changes are likely before then.
During an Ohio House Medicaid Committee hearing this week, Kim Murniecks, DeWine’s budget director, described the trigger language as a way to protect the state’s general fund in the face of uncertainty at the federal level. Nine other states have adopted similar language – Arkansas, Arizona, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia, according to the Kaiser Family Foundation.
“We have constructed this budget based on the parameters, the Medicaid laws, rules and regulations as they exist today,” Murniecks said. “Should they change, we obviously need to work to pivot.”
House Speaker Matt Huffman, a Lima Republican, told Signal potentially ending Medicaid expansion in the face of federal cuts was a reality he and others warned of when the state passed it a decade ago.
“Well here we are 12 years later, and we’re having that conversation,” Huffman said.
The DeWine administration separately is working on imposing work requirements for people covered by Medicaid expansion. The state projects doing so could cause 60,000 people to lose coverage statewide – the number could be higher or lower, depending on how many people end up being able to comply.
What is Medicaid expansion and who is qualified to receive it?
Ohio expanded eligibility for Medicaid – the government healthcare program for the poor and disabled – in 2014 under then-Gov. John Kasich, a Republican. Medicaid expansion was a centerpiece of the Affordable Care Act, the federal healthcare law known as Obamacare.
Before Medicaid expansion, people without children generally weren’t eligible for Medicaid unless they were pregnant or disabled. After the change, all households became eligible if they made less than 138% of the federal poverty level, currently $44,367 a year for a family of four.
Today, 770,000 Ohioans are covered under Medicaid expansion, according to state data. About 3 million Ohioans, or around a quarter of the state’s population, are on Medicaid overall.
The federal government generally covers around two-thirds of the costs of Medicaid, and the state pays for the rest. But for people covered under Medicaid expansion, it covers 90% of the costs. This higher federal match was meant to help convince states to accept Medicaid expansion in the first place, especially in Republican-leaning states where officials were opposed to expanding a costly government program.
The Medicaid program is projected to cost $48.1 billion in 2026, of which the state government will pay $14.7 billion, according to DeWine’s budget plan. The federal government is supposed to pay for the rest.
More about the ‘trigger law’
Greg Lawson, a research fellow with the Buckeye Institute, a conservative think-tank that backs cuts to Medicaid, said he was surprised that the DeWine administration backs completely ending Medicaid expansion in the event of a federal rate cut.
The Buckeye Institute had testified during a legislative committee hearing earlier in the week in favor of the state freezing future Medicaid expansion enrollment if the federal government cut its share. This would have been less disruptive than abruptly ending coverage.
But Lawson said the state’s budget realities would justify a full end of Medicaid expansion if the feds were to no longer cover 90% of the program’s costs.
“I’m not sure there’s a lot from a financial standpoint that the state is going to be able to do,” Lawson said. “That’s one of the challenges of being on the hook for a program that pays from Washington.”
Tara Britton, director of Public Policy and Advocacy at the Center for Community Solutions, a Cleveland think tank that backs social safety-net programs, said the clause ending Medicaid expansion would have ripple effects among families and the hospital industry if it ends up getting triggered.
Among those who would be quickly affected are those with chronic conditions, employers (whose insurance costs would go up), and rural hospitals, which depend on Medicaid payments, Britton said. Parents who lose Medicaid coverage often assume their children did too – even if they didn’t – and stop attending medical appointments, Britton said.
“But most simply, Medicaid expansion helps thousands of Ohioans and whom without it will be left with limited affordable options,” Britton said.
State Rep. Bride Rose Sweeney, a Westlake Democrat, said lawmakers otherwise would be able to make their own decisions about how to respond if Congress cuts Medicaid expansion funding.
Cuts are ‘terrifying,’ says Ohio’s top Ohio House Democrat
DeWine’s budget bill also contains language that would “reduce, discontinue, pause or suspend” any state program for which its corresponding federal funding was also reduced, discontinued, paused or suspended, and that concerns Democrats. That language at least makes the choice optional for the DeWine administration, Sweeney said.
But the trigger language DeWine wrote for Medicaid expansion takes away lawmakers’ discretion and also ties the administration’s hands. She said the effect is that it politically insulates lawmakers from making a tough vote.
“In a real way, it’s allowing lawmakers to not have direct responsibilities for very likely catastrophic results going forward,” Sweeney said.
Allison Russo, the top Democrat in the Ohio House, said federal Medicaid cuts are House Democrats’ No. 1 concern, and she hopes Ohio’s Republican congressional delegation fights them.
“It is terrifying, and it’s why there were so many in states, including here in Ohio, people talking about the devastating consequences of the Trump administration,” Russo said.
