Is Ohio changing Medicaid requirements?
Yes, Ohio is preparing to implement new Medicaid work and community engagement requirements for certain adult enrollees.
You can review official updates and guidelines directly through the Ohio Medicaid Eligibility Changes Portal.
Key Details of the Upcoming Changes
- Work Requirement: Non-exempt adults aged 19 to 64 will likely need to complete at least 80 hours per month of work, education, job training, or community service to maintain their coverage.
- Affected Group: The rules primarily target expansion-group adults (MAGI Adult / Group VIII) with household incomes up to 138% of the Federal Poverty Level.
- Exemptions: Individuals who are pregnant, primary caretakers of young children or disabled persons, certified veterans with total disabilities, or medically frail/disabled are generally exempt.
- Timeline: Implementation is federally mandated to take effect by January 1, 2027, and the Ohio Department of Medicaid is currently awaiting final federal guidance.
What are the big changes coming to Medicaid?
Major federal changes to Medicaid under the 2025 federal policy and reconciliation legislation (often referred to as the One Big Beautiful Bill Act) are rolling out new eligibility limits, stricter verification, and work requirements.
New Immigration and Residency Rules
- Effective October 1, 2026: Full Medicaid eligibility is restricted for certain noncitizens.
- Who qualifies: U.S. citizens, lawful permanent residents (green card holders, often subject to a 5-year wait), certain children up to age 19, pregnant individuals/those who gave birth in the past year, Cuban/Haitian entrants, and COFA migrants from Micronesia, the Marshall Islands, or Palau can keep or get coverage.
- Who is affected: Many humanitarian immigrants (including refugees and asylum seekers) without permanent resident status lose full eligibility, though limited emergency and pregnancy coverage may remain.
Work Requirements and Recertification
- Effective January 1, 2027: Able-bodied adults aged 19–64 enrolled in expansion or waiver plans face new federal work requirements.
- Work hours: Enrollees generally must complete an average of 20 hours per week (or 80 hours per month) of work, school, or qualifying community activities.
- Exemptions: Exemptions exist for primary caregivers (such as those caring for individuals with disabilities), verified health conditions, or pregnancy, though proving these exemptions requires strict, frequent documentation.
- More frequent renewals: Enrollees will undergo mandatory eligibility redeterminations every six months instead of annually.
- Retroactive coverage: Retroactive coverage for medical bills prior to enrollment is reduced significantly (down to 30–60 days depending on the state and age group).
What changes will Ohio Medicare make in 2026?
Ohio Medicare changes for 2026 include a new prior authorization pilot program for traditional fee-for-service beneficiaries, adjustments to plan options, and statewide rollouts for dual-eligible residents.
Key 2026 Medicare Changes in Ohio
- WISeR Pilot Program: Ohio is one of six states participating in the Wasteful and Inappropriate Services Reduction (WISeR) model starting January 1, 2026. Traditional Medicare and Medigap beneficiaries must get prior authorization with AI support for 17 overused procedures (such as certain spinal and knee surgeries).
- Next Generation MyCare Ohio: Dual-eligible residents (those with both Medicare and Medicaid) transition to the updated Next Generation MyCare program, which coordinates care under selected statewide plans like Anthem, CareSource, and Molina.
- Medicare Advantage Availability: Ohio offers 212 Medicare Advantage plans for 2026 (down slightly from 217 in 2025), with average monthly premiums decreasing slightly to $13.54 and $0-premium options widely available.
- Part D and National Updates: Stand-alone Part D prescription plans feature 10 options with low- or zero-dollar premiums, alongside national changes like the $2,100 out-of-pocket spending cap.
What is the income threshold for Medicaid in Ohio in 2026?
For non-disabled adults aged 19–64, the Ohio Medicaid income threshold is 138% of the Federal Poverty Level (FPL), which is approximately $1,835 per month ($22,025 per year) for a single person.
Income Limits by Group (2026 Guidelines)
Income limits vary depending on your household category and size:
- Adults (Ages 19–64): 138% FPL
- 1 person: $1,835 / month
- 2 people: $2,399 / month
- 3 people: $3,028 / month
- 4 people: $3,658 / month
- Pregnant Individuals: Up to 205% FPL
- 1 person: $2,726 / month
- 2 people: $3,715 / month
- Children (Ages 18 and under): Up to 211% FPL
- 1 person: $2,806 / month
- 2 people: $3,804 / month
- Long-Term Care / Special Income Level (SIL): 300% of the SSI Federal Benefit Rate, capped at $2,982 per month for a single applicant.
You can review complete program standards or submit an application through the official Ohio Benefits Portal.
What are the new laws for 2026 in Ohio?
Ohio implemented several major new laws and regulatory changes taking effect through 2026, as outlined by the WTOL 11 Legislative Guide.
📅 Daily Life & Labor
- Minimum wage increased to $11.00 per hour.
- Tipped employee minimum wage rose to $5.50 per hour.
🏫 Education & Schools
- Public schools banned student cellphone use all day.
- Schools must stock overdose reversal drugs like Narcan.
🚗 Driving & Public Safety
- Drivers must provide ID during traffic stops.
- Passengers must identify themselves under reasonable suspicion.
- Keith's Law expanded the communication disability database.
🌿 Marijuana & Hemp
- Senate Bill 56 moved intoxicating hemp to dispensaries.
- THC retail beverages faced a swift ban.
🗳 Elections
- Absentee ballots must arrive by election day close.
- The four-day post-election grace period ended.
How many Ohioans could lose Medicaid under new federal requirements
Who will be disqualified from Medicaid?
Certain noncitizens without green cards, individuals exceeding income or asset limits, and adults who fail to meet upcoming work requirements or document medical exemptions face disqualification from Medicaid under New Medicaid eligibility rules.
Recent Immigration and Status Changes
- Noncitizens without green cards: Lawfully living immigrants without green cards lost routine federal Medicaid coverage starting October 1, 2026, transitioning only to emergency services, with narrow exceptions.
- Exempt groups: Lawful permanent residents of five or more years, Cuban and Haitian immigrants, and specific humanitarian groups retain eligibility.
Upcoming Work Requirements (Starting 2027)
- Work rules: Low-income adults relying on Medicaid may lose benefits if they do not fulfill 80 hours per month of work or community engagement.
- Medical exemptions: Those who are not automatically exempt via severe medical conditions (Tier 1) must provide robust documentation (Tier 2 and Tier 3) proving they are too sick to work.
Financial and Administrative Disqualifications
- Income and asset limits: Exceeding state limits on monthly income or countable assets (such as cash savings or secondary properties) results in denial or loss of coverage unless a formal "spend-down" occurs.
- Asset transfers: Transferring assets below market value within the 60-month (5-year) look-back period triggers penalties and disqualification.
- Paperwork errors: Missing agency renewal deadlines or submitting incomplete verification documents leads to administrative termination.
What states are cutting Medicaid?
Several states are cutting Medicaid provider reimbursement rates, reducing program budgets, or implementing new cost-sharing rules following federal funding reductions from federal legislation (such as H.R. 1 / the reconciliation law passed in 2025) and state budget shortfalls.
States Directly Cutting Payments or Budgets
- North Carolina: Cut overall provider pay by at least 3% (including 8% for primary care and 10% for specialists) and faces major funding and service reduction pressures.
- Idaho: Implemented an across-the-board 4% provider payment cut and reduced disability service funding to address budget gaps.
- Washington State: Approved hundreds of millions in program cuts and tracking coverage gaps affecting thousands of low-income residents and immigrants.
- Colorado: Suspended planned Medicaid rate increases and cut some dental spending.
- Arizona: Reduced state agency and program budgets by 5%.
- Missouri: Cut specific related child care and support allocations.
- Montana and New Hampshire: Initiated steps to introduce enrollee cost-sharing and monthly premiums.
States Facing the Deepest Projected Cuts
Under upcoming federal caps on state-directed payments and financing changes from federal rules, nearly three dozen states face major reductions (10% to 25% drops in high-rate mechanisms). The states facing the most severe structural and budget impacts include:
- California and New York (experiencing the largest reductions in total dollar value)
- Arizona, Iowa, and Nevada (facing budget reductions exceeding 15%)
- Nebraska, Louisiana, South Carolina, Kentucky, New Mexico, Illinois, Tennessee, Florida, Georgia, and Mississippi
Track ongoing developments and state-specific policy responses through resources like KFF and State Health and Value Strategies.
Who will lose Medicare in 2026?
No broad groups of people are losing traditional Medicare in 2026, but some Medicare Advantage enrollees face forced plan terminations, and roughly 100,000 lawfully present immigrants are projected to lose Medicare later due to recent federal legislation.
Medicare Advantage Changes
- Forced Disenrollment: According to Johns Hopkins Bloomberg School of Public Health, about 1 in 10 Medicare Advantage enrollees face forced plan disenrollment in 2026 as insurers scale back offerings.
- Network Drops: Major health systems nationwide have dropped specific Medicare Advantage plans due to disputes over prior authorization and reimbursements.
Immigrant Eligibility and Future Cuts
- Medicaid vs. Medicare: Recent changes from the federal spending law (such as the One Big Beautiful Bill Act) primarily target Medicaid eligibility for certain lawfully present immigrants starting October 1, 2026.
- Medicare Impact: While Medicaid changes took effect in late 2026, the Congressional Budget Office estimates that roughly 100,000 lawfully present immigrants could eventually lose Medicare coverage, with formal terminations anticipated around February 1, 2027.
What is the income limit for Medicare in Ohio?
There is no general income limit to qualify for standard Original Medicare in Ohio, as eligibility is based on age (65 or older), disability, or specific health conditions rather than income.
However, if you have a lower income, you may qualify for financial assistance programs in Ohio—such as Medicare Savings Programs (MSP) or Extra Help—which do have specific monthly income and asset limits.
Medicare Savings Program Income Limits (2026)
Ohio's Medicare Premium Assistance Programs (MPAP) help pay for Part A and Part B premiums, deductibles, and co-pays based on these gross monthly income limits:
- Qualified Medicare Beneficiary (QMB):
- Individual: $1,350 per month (Asset limit: $9,950)
- Married Couple: $1,824 per month (Asset limit: $14,910)
- Specified Low-Income Medicare Beneficiary (SLMB):
- Individual: $1,616 per month (Asset limit: $9,950)
- Married Couple: $2,184 per month (Asset limit: $14,910)
- Qualified Individual (QI):
- Individual: $1,816 per month (Asset limit: $9,950)
- Married Couple: $2,455 per month (Asset limit: $14,910)
What are the five things that Medicare will not cover in 2026?
Original Medicare (Parts A and B) does not cover routine dental care, routine vision care, hearing aids, long-term custodial care, and health care received overseas.
Major Uncovered Services in 2026
- Most dental care: Original Medicare does not pay for routine cleanings, checkups, fillings, tooth extractions, root canals, or dentures.
- Routine vision care: Regular eye exams, eyeglasses, and contact lenses are excluded, though treatments for medical eye conditions like cataracts or glaucoma are covered.
- Hearing aids: Original Medicare does not cover hearing aids or routine exams used to fit them.
- Long-term care: Extended nursing home care or custodial care (help with daily personal activities like bathing or dressing) is not covered outside of limited short-term skilled nursing rehabilitation.
- Overseas coverage: Medical care received outside of the United States and its territories is generally excluded, with rare exceptions like emergencies on cruise ships close to a U.S. port.