Ohio medical professionals oppose Medicaid work requirement proposal
By Zurie Pope, Ohio Capital Journal / February 20, 2025
Ohio medical professionals are worried about proposed work requirements for Medicaid, fearing that if implemented, they would place barriers to care for patients who need it most, emails obtained and interviews conducted by the Ohio Capital Journal show.
Ohio’s 2023 budget requires the state Medicaid department to reapply with the federal government under the Trump administration for permission to impose work, drug testing, or education requirements for adult recipients of Medicaid.
The Ohio Department of Medicaid’s proposal would require adults younger than 55 to prove they worked at least 20 hours a week to qualify for Medicaid, or have an exception, such as school enrollment or intensive physical care needs. Hundreds of Ohioans have submitted comments to the Ohio Department of Medicaid opposing the move.
More than a dozen states had Medicaid work requirement programs approved during Trump’s first administration.
Two states, Georgia and Arkansas, are now in the process of scaling the requirements back after unforeseen expenses and administrative burdens.
More than 90% of U.S. adults eligible for Medicaid expansion are already working or could be exempt from requirements, according to the Kaiser Family Foundation.
Ohio Gov. Mike DeWine said in a Dec. 17 statement on the proposal that his goal is to empower all people to reach their full potential.
“While this certainly includes providing critical assistance to people when they need it, we also have a responsibility to ensure as many Ohioans as possible are on a pathway to financial independence,” DeWine said.
The Ohio Department of Medicaid estimates that at least 61,826 Ohioans would lose access to Medicaid under the new rules.
However, research from the Center for Community Solutions — a health policy think tank in Cleveland — found that 450,000 Ohioans could lose health coverage if the work requirement goes into effect.
The center said that Pike County has the highest percentage of the working-age population who is at risk, 15.9% That’s followed closely by Scioto County at 15.2%. Eleven other counties are above 10%, the center’s research shows.
Comments from medical professionals to the Ohio Department of Medicaid
Among the hundreds who submitted comments to the Medicaid department voicing opposition, several were doctors, nurses and clinicians, discussing how the plan would affect health outcomes for all Ohioans.
“I work with patients who are on Medicaid, many of whom are not able to work due to physical and mental health concerns,” wrote Alex Fay, a registered nurse in Cleveland on Jan. 16. “Who will decide what qualifies as working or searching for work, and who is too sick or ill to work? What about patients with circumstances such as being homeless or in a domestic violence situation — will they be expected to work?”
Lindsey Johnson, a clinical counselor from Columbus, noted that she works in community mental health and that the vast majority of her clients use Medicaid.
“Their Medicaid coverage is fundamental to their well-being,” she said. “Medicaid insurance is a basic human right and without it, my clients’ physical and mental states would inevitably worsen — resulting in more homelessness and expensive trips to the emergency room.”
Amber Prater, a medical student at the University of Dayton, wrote about existing inequality in the health care system.
“Patient populations that benefit from Medicaid already experience significant disparities in health care, and increased eligibility requirements and administrative tasks would likely cause many to lose their insurance coverage, increasing health inequity in Ohio,” she said.
Miranda Yaver, an Assistant Professor of Health Policy and Management at the University of Pittsburgh, said work requirements won’t increase employment.
“Extensive research on the subject has consistently demonstrated that this is simply not true,” Yaver wrote.
Yaver cited a study conducted by Harvard physician Benjamin D. Sommers published in September 2020. In it, Sommers and his colleagues used a phone survey of 2,706 low-income adults to analyze the results of Arkansas’s work requirement program.
They discovered that work requirements didn’t increase employment, despite 18 months of follow-up. Worse still, “people in Arkansas ages 30–49 who had lost Medicaid in the prior year experienced adverse consequences: 50% reported serious problems paying off medical debt, 56% delayed care because of cost, and 64% delayed taking medications because of cost.”
Yaver notes the results, writing “ these are not health outcomes to which we should aspire replication.”
Another respondent claims the Ohio Department of Medicaid misrepresented her work to justify their proposal.
“On its first page, the waiver application referenced here erroneously cites a paper I published with my colleague Dr. Laura Gottlieb in 2014 as supporting work requirements in Medicaid, without presenting a single quotation or even a page number from the article as an example,” wrote Paula Braverman, professor of Family and Community Medicine at the University of California.
The application states “there is a strong connection between improved health and being employed and engaged in one’s health choices,” and links to the report Braverman and Gottlieb published.
“Our work does not support work requirements in Medicaid,” Braverman wrote definitively. “Denying people medical care if they don’t have paying jobs is cruel and inhumane.”
The history of Medicaid work requirements
Since then, Republican-led states have supported work requirements, often with think tanks like ALEC and Americans for Prosperity supporting them.
In Ohio, think tank The Buckeye Institute supports the state asking for the work requirement waiver.
The Buckeye Institute’s vice president of policy, Rea Hederman Jr., said that adding work requirements encourages self-sufficiency and lifts Medicaid users out of poverty.
“Medicaid is a program that discourages work effort, because enrollees can lose benefits when their earnings surpasses the income limit,” Hederman Jr. said. “When working, employees gain not just wages but also work experience which increases wages in the long-run. The consequence is that Medicaid enrollees can lose out on hundreds of thousands of dollars they would have gained if they were working consistently.”
Kathryn Poe, a researcher for think tank Policy Matters Ohio, disagrees.
“Shockingly, this is one of the few areas of policy where there is no evidence to support it,” Poe said, pointing to other states that have tried work requirements. “What you see resoundingly from all of the data from these programs is that they do not work. They increased administrative burden. They increased the amount of a state has to spend per person. They are often really confusing for people, both in the government and outside of the government, but they resoundingly kick people off of their coverage.”
President Donald Trump has advocated for work requirements since his first term in office, and many see his return to the White House as an opportunity to launch such programs nationwide. U.S. House Speaker Mike Johnson has made tying work to Medicaid a key part of budget negotiations for the 2025 spending bill.