Hundreds of thousands of children in Ohio are covered by public health insurance such as Medicaid, which could be subject to major changes and cuts as the presidential administration reviews the nominations of Project 2025 authors and supporters for key roles.
Meanwhile, Ohio faces a novel two-year budget cycle in 2025, during which lawmakers and the governor will address, among other things, Medicaid, any potential federal cuts and funding for novel child welfare laws passed just before the novel year.
The federal Medicaid program includes the Children’s Health Insurance Program (CHIP) and covers 79.4 million Americans nationwide, focusing primarily on people who are low-income or disabled. Data from the Ohio Health Policy Institute showed that more than 700,000 Ohio children ages 6 to 18 were on Medicaid during the 2022–2023 school year.
More than a decade ago, the federal government enabled flexibility in school health services for students covered by Medicaid, which HPIO recommended to expand services across the state to improve student health and wellness outcomes.
“Children from low-income families who are therefore eligible for Medicaid often experience greater barriers to accessing health care due to factors such as lack of transportation or challenges for parents to take time off work,” according to the study. HPIO report on school health care and Medicaid released in December.
Condition Medicaid Schools Program also uses Medicaid reimbursement to allow schools to provide “school therapy services” to students receiving Medicaid as part of the students’ Individualized Education Plan (IEP).
The county with the highest student enrollment rate in Ohio was Hocking County at 53.7%. It was one of 22 counties where the school enrollment rate ranged from 42.6% to 53.7%, the highest range in the state. According to HPIO, another 22 counties have enrollment rates ranging from 34.8% to 42.1%, and 22 counties have enrollment rates ranging from 27.9% to 34.6%. Delaware County had the lowest enrollment rate in the state at 9.9%.
However, a novel Republican majority in the House and a change of hands at the presidential level could mean less funding for the Medicaid program and an impact on state-level programs.
Rumors about changes in American health care began with the Project 2025 document prepared by the conservative Heritage Foundation, whose authors and supporters were nominated to serve in the Trump administration. The Center for Budget and Policy Priorities determined that Project 2025 plans, along with those of the Republican study committee and the U.S. House of Representatives Budget Committee, could lead to an raise in the number of uninsured Americans and overall health care costs.
Publicly disclosed plans would cut funding and change Medicaid regulations, including: rolling back expansion of the Affordable Care Actas well as the move to block grants and another attempt to add job requirements to adult Medicaid eligibility, which Ohioans have noted in state-level discussions about the program only on December 17.
With Ohio’s biennial operating budget set to be approved this year, it is not yet clear how these changes may impact the funding requests in Gov. Mike DeWine’s executive budget proposal when it comes to child welfare or How will the state prepare for the impact if Medicaid funding cuts come from the federal level.
Medicaid decisions could impact one law in particular that hopes to receive funding in the next state budget. House Bill 7 was passed at the end of the yearalthough it was adopted without the financial resources originally included in the project.
The novel law focuses on various programs and aspects of state supervision over child development, parenting, and infant and maternal mortality.
Although the law does not yet include any novel funding, HB 7 passed with provisions directing the Ohio Department of Medicaid to conduct a study on reimbursement for “evidence-based peer-to-peer programs that support infant vitality,” including: purposes of law.
While the bill was still before the Ohio Senate Finance Committee, the Ohio Psychological Association praised the bill’s bipartisan sponsors for including a provision that would require the Ohio Department of Medicaid to explore “pathways” for youth mental health reimbursement.
The law would also require the ODM director to develop “policy and billing guidelines” for Medicaid-covered providers. It also requires the Director to submit a report to the Governor and the General Assembly outlining stakeholder engagement with ODM’s procedures for coverage of early childhood mental health services and an accounting of the number of families and children served, as well as services and program outcomes, in accordance with Legislative Service Commission Analysis bill.
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