Witness urges Ohio to pursue work requirements, stricter verification and waivers to curb Medicaid costs

Trevor Carlson, a visiting fellow with Opportunity Solutions Project, told an Ohio House committee that the state’s Medicaid expansion and weak eligibility-verification practices have driven enrollment and what he described as large improper payments, and urged lawmakers to pursue federal waivers and state policy changes to reduce costs.

Carlson told the committee that Ohio’s Medicaid expansion population — able-bodied adults added under the Affordable Care Act — has grown far beyond projections and that higher enrollment has produced budgetary stress. “By 2020 enrollment reached nearly 750,000, more than 60% above what had been promised,” Carlson said, adding that average monthly enrollment for fiscal year 2024 topped about 860,000 expansion adults and at one point exceeded 1,000,000.

Why it matters: Carlson argued that the expansion population is financed differently from traditional Medicaid groups and that some federal rules that rewarded expansion (a 90% federal match for expansion adults) have increased state exposure to changing federal policy. He said improper payments and eligibility errors divert funds from core services for vulnerable Ohioans.

Carlson summarized how Medicaid eligibility groups differ, noted Ohio’s primary Federal Medical Assistance Percentage (FMAP) of about 65%, and explained…