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.


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.