Ohio’s Medicaid Work Requirement Efforts Aim to Boost Engagement, Avoid Coverage Loss

As the national debate over Medicaid work requirements heats up, Ohio is moving forward with a plan to tie coverage to work or community participation, all while there is much pushback in the industry.

The move came in February, not too much longer after Congress introduced a bill in the same month that would require most Medicaid consumers ages 18 to 65 to work or volunteer at least 20 hours per week unless they qualify for an exemption.

The proposal is gaining support, but many in the healthcare industry are concerned, as reports say it could cause millions to lose their Medicaid coverage—especially if they have trouble with the paperwork or don’t understand the rules.

Maureen Corcoran, director of the Ohio Department of Medicaid, believes the work requirement policy can be both a financial and moral effort to improve the lives of Medicaid consumers.

In a recent interview with Managed Healthcare Executive, she outlined the state’s approach to balancing coverage protection with efforts to engage recipients in meaningful daily activities like employment or volunteering.

Maureen Corcoran

“Having a meaningful set of activities in your life, whether it is work or volunteer or other community engagement, is important to our mental and physical health,” she said, adding that the initiative aligns with public health goals and community values. “It is completely consistent with our mission of every Ohioan having good healthcare and good health.”

Corcoran noted that the intent isn’t to take coverage away but to promote wellness and responsible program stewardship.

Related: Jennifer Haley Debunks the Belief That Medicaid Work Requirements Will Push Its Users to Work

Not all Medicaid recipients would be required to work, she added.

Ohio’s proposal—pending approval from CMS—is based on 2023’s House Bill 33.

This House bill requires that able-bodied adults under age 55 meet employment or community engagement criteria to remain eligible for Medicaid.

Exemptions apply to those 55 or older, enrolled in school or job training, undergoing addiction recovery, or living with serious health conditions or mental illness, she said.

Those already working also meet the requirement.

To reduce the burden on recipients, the state plans to use existing data sources to determine eligibility and exemptions.

“If you qualify, you won’t be asked for additional paperwork,” Corcoran said.

For example, in December 2024, more than 325,000 of the state’s roughly 800,000 Medicaid recipients were already working at least 10 hours a week.

About 30% were exempt due to age, substance use disorder or health conditions. That leaves approximately 210,000 individuals who would need to be assessed.

To avoid coverage loss among eligible enrollees, Ohio has created a broad communication strategy, Corcoran mentioned.

Managed care plans will reach out through texts and early renewal reminders and will offer help navigating the system. The state is also partnering with grassroots groups, food banks, shelters and disability advocates to ensure consistent and accessible outreach.

In addition, Ohio plans to use AI tools and data-sharing systems to assess eligibility and only request documentation when necessary.

The state is among several states pushing for this policy.

According to KFF’s Medicaid Waiver Tracker, Georgia is the only state with a CMS-approved work requirement as of April 17, 2025.

Arizona and Arkansas have waivers pending, while nine other states—including North Carolina, South Carolina, Iowa, Kentucky and Montana—have related legislation underway.

These efforts depend on Section 1115 waivers, which allow states to test new Medicaid policies as long as they meet federal budget rules and support program goals.

However, experts remain concerned.

The Urban Institute estimated up to 5.2 million Medicaid enrollees could lose coverage nationwide, largely due to confusion over reporting or administrative barriers, even among people who meet the requirements.

In Ohio, state projections suggest around 62,000 consumers could be affected.

Corcoran acknowledged the risk but stressed that the state is working to help individuals who no longer qualify transition to the health insurance marketplace.

“Everything we can to hand people off to the [insurance] marketplace if they can afford it,” she said, noting that subsidies are available for low-income residents. Medicaid can also retroactively cover up to three months of care for eligible individuals who reapply.

To ensure transparency and track progress, the state will use performance dashboards and outcome targets, she said.

Oversight will come from caseworkers and managed care plans, and third-party vendors may help reach harder-to-serve populations.

Financial incentives for counties could also be introduced to promote outreach and compliance, Corcoran added.

Corcoran stressed that the demonstration waiver must meet rigorous evaluation standards.

“It must have an external research component, not just an evaluation,” she said, referencing federal requirements under Section 1115 of the Social Security Act.

Through data integration, targeted outreach and a careful rollout, Corcoran said Ohio aims to make sure eligible residents stay covered.

“We’re fully committed to reaching as many people as possible,” she said.