Medicaid feature image Source: Ohio Department of Medicaid, Health Policy Institute of Ohio


Medicaid and the Children’s Health Insurance Program provide health care coverage for people with disabilities and for low-income Ohioans — families and children, pregnant women and the elderly. Today, one in four Ohioans is enrolled in Medicaid, with 83,000 active providers caring for 3 million individuals.
The Medicaid program is jointly funded by states and the federal government. In Ohio, the current Federal Medical Assistance Percentage, or FMAP, for most Medicaid expenditures is 63.02%; 85.6% for children; and 93% for Medicaid expansion.


Connect here to view Medicaid-specific Finance News prepared by OHA's Health Economics & Policy team.

Ohio Large Provider Group

OHA members can log in and view details of large privder quarterly meetings of the Large Provider Group here.


Medicaid was the payer in 22% of Ohio hospital encounters in 2017 reimbursing hospitals 79 cents on the dollar for the cost of caring for Medicaid beneficiaries. Ohio hospitals serving a disproportionate share of poor and disabled Ohioans received $388 million in supplement payments in 2016 though hospitals statewide posted a $2.3 billion loss on Medicaid reimbursements.


Ohio expanded Medicaid program eligibility in 2014 to include additional uninsured adults with incomes up to 138% of the federal poverty level. In state fiscal year 2018 the expansion group accounted for 24% of Ohio’s Medicaid enrollment.
To be eligible for Medicaid coverage, individuals must:

  • Be a United States citizen or meet Medicaid citizenship requirements
  • Have or get a Social Security number
  • Be an Ohio resident
  • Meet financial requirements according to Modified Adjusted Gross Income


The Ohio Department of Medicaid reports beneficiaries and expenses by four eligibility categories. Each group has its own income requirements:

  • Covered Families and Children, or CFC—Pregnant women, infants and children
  • Group VIII, expansion population—Individuals at or below 138 percent of the federal poverty level, including childless adults
  • Aged, Blind and Disabled, or ABD—Individuals with disabilities
  • Other—Including elderly


Medicaid assists in paying for:

  • Inpatient and outpatient hospital care
  • Physician, midwife and specific nurse practitioner care
  • Laboratory and x-ray services
  • Nursing home and home health care
  • Early and periodic screening, diagnosis and treatment for children under age 19
  • Family planning
  • Rural health clinics/federal qualified health centers
  • Prescription drugs


OHA's Health Economics & Policy team has helped members navigate the Ohio Department of Medicaid's State Innovation Model, or SIM, test of multi-payer, value-based payment models. OHA analysts and member hospitals are providing feedback to the state as it works to transition to value-based alternatives to fee-for-service payments for care.  

The state has received a federal grant for SIM testing. Ohio's SIM focuses on increasing access to patient-centered medical homes and implementing episode-based payments. Read more about the program here.