About 774,000 Ohioans are enrolled in Medicaid as working-age expansion adults, and the Ohio Department of Medicaid expects roughly 62,000 of them to lose eligibility during the state’s 2026-27 budget period as the new work rule takes hold. Beginning January 1, 2027, adults 19 to 64 in that group must show 80 hours a month of work or approved activities, or income of at least $580 a month, and renew their coverage every six months.
The enrollment and loss figures come from a February 2026 department presentation, which lists the group’s total at 774,342 and says ODM is “estimating that ~62,000 enrollees will lose their Medicaid eligibility” in that period.
Who Ohio puts in the expansion group
The state calls the group Group VIII. Its partner packet describes adults 19 to 64 whose Medicaid is based on income at or below 138 percent of the federal poverty level. The packet’s examples are $22,025 a year for one person and $37,702 for a family of three.
The same packet exempts people outside that age range and those eligible under a different category, including anyone enrolled in Medicare Part A or B. That is why the rule falls mainly on working-age adults who have no disability finding, no young child at home and no other pathway into Medicaid.
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The Health Policy Institute of Ohio, in a June 30 explainer by Brian O’Rourke, puts expansion enrollment at about 700,000 and notes that the federal law requires every state to have the rule in place by January 1, 2027.
What counts toward the 80 hours
The packet lists several ways to reach 80 hours a month: paid work or self-employment, unpaid caregiving, work in exchange for goods or housing, internships, community service, a recognized work program such as OhioMeansJobs, school at least half time, or any combination that adds up to 80.
The income route is separate. Earning at least $580 a month meets the rule, a figure the department says equals the federal minimum wage times 80 hours. Seasonal workers may use their average monthly income instead of a single month’s pay.
Applicants face the test at the front door. Summit County’s job and family services page says new applicants must show they met the requirement in the month before applying, while people renewing must show it for at least one month since their last application or renewal.
Who does not have to meet it
Ohio’s exemption list is long. It includes former foster youth under 26, Native Americans and people eligible for Indian Health Service care, parents or caretakers of a child 13 or younger or of a disabled person, family caregivers, veterans with a total disability rating, and people in drug or alcohol treatment.
Also exempt are medically frail adults, pregnant and postpartum people, those released from incarceration in the last three months, participants meeting TANF work rules and certain SNAP household members. The department says it identified 1,935 diagnosis codes, counting subcodes, that mark someone as medically frail, using the past year of diagnoses or five years for substance use disorders.
The department’s February figures give a sense of scale. It counted 601,882 members, or 77.7 percent, as already meeting the statutory requirements through work, disability, parenting or age, and 172,460 who need an individual assessment.
How the six-month renewals and proof work
The packet says that “beginning January 1, 2027, federal law will require renewals to take place every six months.” Renewals started on or after that date are checked for the work rule, so the first ones come due in March 2027.
The department says a member only needs to show an exemption or compliance for at least one month since the last renewal, not every month. Pay stubs covering 30 days of income, an employer letter, self-employment records, a class schedule, a volunteer letter with scheduled hours or a doctor’s statement can all serve as proof. Documents go to the county Department of Job and Family Services.
Ohio will first try to confirm the facts itself. The February presentation lists data matches with the IRS, Social Security, state unemployment and the national directory of new hires, so some members will clear the check without sending anything.
What happens when proof does not arrive
If the state cannot confirm compliance, it sends a notice and opens a 30-day period for the member to supply more information. According to the packet, failing to do so results in an application being denied or benefits being discontinued, with a notice that explains how to request a state hearing. Reapplying is allowed at any time.
Members must also report changes in income, address, household or pregnancy to the county within 10 days. The packet points to the Ohio Benefits portal at benefits.ohio.gov, mail or a county office, and lists the Ohio Medicaid Consumer Hotline at (800) 324-8680.
Many members have already received a warning. Summit County said state letters began mailing in August 2026 and ran into early September, and that receiving one does not mean coverage is changing immediately. Patrick Beatty, the department’s deputy director for the work and community engagement requirements, led the February briefing that laid out the timeline.
For adults on Ohio’s expansion plan, the practical question before January is which box they fall into: working or active, exempt, or needing proof the state cannot find on its own.
On Ohio Medicaid and unsure which box applies?
The risk in Ohio is not the rule itself but the paperwork. A member who is exempt can still lose coverage after a missed notice, and a member who works can lose it by not sending the proof in the 30-day window.
The SNAP & Medicaid Renewal Organizer includes a section on the new Medicaid work requirement and who is exempt, along with 51 state packs and a renewal calendar, so an Ohio household can check its situation against the exemptions and see which dates matter.
See the Medicaid work-rule exemption guide in the renewal organizer for Ohio households →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
