Medicaid expansion helped Ohio, but now hinges on federal funding

Ohio’s expansion of Medicaid significantly increased health coverage across the state and helped stabilize access to care, including maternal and reproductive health services. The state has also extended postpartum Medicaid coverage, improving continuity of care after childbirth.

At the same time, continued coverage is now closely tied to federal policy decisions. Ohio’s 2026–2027 state budget includes a provision that would automatically end Medicaid expansion if the federal government reduces its enhanced funding share. Even without triggering that provision, proposed federal Medicaid funding cuts could strain hospitals and providers—particularly in rural areas—where access to care is already uneven.

Why it Matters

Medicaid plays a central role in healthcare access for women, especially during pregnancy and the postpartum period. In Ohio, Medicaid expansion has helped keep hospitals open, supported maternity care, and reduced gaps in coverage for low-income patients.

If federal funding is reduced, hospitals and clinics may be forced to cut services, limit capacity, or close entirely. These impacts tend to fall hardest on rural communities, where healthcare options are already limited, and travel distances for care are longer. Even without changes to eligibility, funding cuts can quickly affect whether services are available when and where people need them.

Background

Ohio expanded Medicaid under the Affordable Care Act, extending coverage to hundreds of thousands of residents and reducing the state’s uninsured rate. The expansion has been particularly important for women of childbearing age and for communities with limited access to employer-sponsored insurance.

The state later adopted a federal option to extend postpartum Medicaid coverage to 12 months, improving access to follow-up care after childbirth and addressing gaps that previously left many new parents uninsured.

Despite these gains, healthcare access in Ohio remains uneven. Provider shortages, hospital service reductions, and low reimbursement rates continue to affect availability—especially in rural areas. Many rural hospitals rely heavily on Medicaid reimbursements to remain financially viable.

In 2025, reporting highlighted concerns that proposed federal Medicaid funding cuts could have significant consequences for Ohio’s healthcare system. While the timing and scope of any cuts remain uncertain, healthcare leaders warned that reduced federal support could accelerate service reductions or hospital closures, affecting prenatal care, labor and delivery services, and emergency care.

Resources

March of Dimes - Maternity Care Desert: Ohio 2024 Report
KFF - Status of State Medicaid Expansion Decisions (scroll down to Ohio)
The Center for Community Solutions - Initial reflections on the 2026-2027 Ohio budget