COLUMBUS, Ohio — Gov.-elect Amy Acton says her administration will make it easier for Ohioans to get on Medicaid and stay on it, renewing a campaign pledge in her first local television interview since winning the Nov. 3 election — even as a federal law set to take effect days before she takes office adds the biggest new eligibility hurdles the program has seen in years.
“As governor, I will protect against attacks on Medicaid and Medicare from Columbus and Washington by helping Ohioans enroll and stay on Medicaid by eliminating unnecessary red tape, shortening approval wait times and eliminating the waste, fraud and abuse that drives up costs and jeopardizes Ohioans’ care,” Acton wrote in her campaign’s health care plan, the commitment she returned to in the interview Friday.
In that interview, Acton pointed to the federal changes scheduled for January 2027 and to Ohio hospitals, rural and urban, that she said are already failing. She said she intends to work with the Ohio attorney general and the state’s congressional delegation and to push back on federal funding changes she argued hospitals need to stay open. She cited former Gov. John Kasich’s decision to expand Medicaid as cost-effective, arguing that when people go uninsured, the cost of their care does not disappear — it shifts to everyone else.
What changes in 2027
The changes come from Public Law 119-21, the federal budget reconciliation law enacted July 4, 2025. Its Medicaid provisions are phased in over several years, but the two largest land on Jan. 1, 2027 — ten days before Acton is sworn in on Jan. 11.
Beginning that day, Ohio must condition Medicaid coverage for most adults ages 19 to 64 in the expansion group — Ohio’s Group VIII, adults covered because their income is at or below 138 percent of the federal poverty level — on “community engagement”: at least 80 hours a month of work, a work program, community service or at-least-half-time schooling, or monthly earnings of at least $580. The same law requires those enrollees’ eligibility to be renewed every six months instead of every twelve.
Some groups are excluded from the work requirement by statute, including pregnant women, parents caring for a child under 14, people who are medically frail or disabled, veterans with a total disability rating, and people already meeting food assistance or cash assistance work rules. People who cannot be verified as compliant get a notice and 30 days to respond before coverage is denied or ended.
Other pieces of the law are already in force or arrive later. Federal funding for several categories of lawfully present immigrants narrowed on Oct. 1, 2026. Retroactive coverage for expansion adults shrinks from three months to one month on Jan. 1, 2027. New provider taxes — one of the tools Ohio uses to finance its share of Medicaid — are barred, and most existing tax rates phase down between 2028 and 2032. Payments Ohio directs to hospitals through managed care plans are capped at Medicare rates instead of commercial rates. Mandatory copays for some expansion enrollees begin in October 2028.
Congress wrote the law so that the core rules cannot be waived: the work requirement is expressly outside the federal waiver authority governors sometimes use to reshape Medicaid. What a governor does control is how the machinery runs — how much verification the state completes from data it already holds before asking enrollees for paperwork, how outreach is done, and whether the state asks Washington for a good-faith delay, which federal law allows only until the end of 2028.
The Ohio numbers
More than 3 million Ohioans — about one in four residents — are enrolled in Medicaid, according to the state auditor’s October performance audit of the Ohio Department of Medicaid, a program spending more than $40 billion a year.
The department’s own count, as of June 2026, put 714,447 Ohioans in the expansion group subject to the new rules. State data already showed 560,186 of them — 78 percent — meeting the law’s requirements, most through employment, disability or another eligibility category. The remaining 154,261 people, about one in five, were flagged as requiring assessment: the state could not yet confirm from its records that they are working, exempt or otherwise compliant.
The outgoing administration built the system Acton will inherit. Under Gov. Mike DeWine, the Department of Medicaid has already mailed notices to affected enrollees, published guidance for providers and community partners, and set its enforcement calendar: applications filed on or after Jan. 1 will be judged under the new requirement, renewals will be evaluated beginning with those initiated on or after Jan. 1, and the first disenrollments for noncompliance would take effect May 1, 2027. The department and the Ohio Department of Job and Family Services also piloted an employment-support program in 2025 aimed at connecting expansion enrollees with help finding work.
Medicaid is also at the center of a separate state fight: the DeWine administration’s six-month freeze on enrolling new home-care providers, an anti-fraud measure imposed in May, is set to expire Nov. 14 unless the state seeks a federal extension.
What happens next
Acton’s transition, launched Nov. 5 under former Strickland chief of staff John Haseley, has not yet named the officials who will run Medicaid or health policy in her administration. She has not said whether Ohio will seek the federal good-faith delay, whether the state will join other states’ court challenge to how federal regulators defined medical frailty under the new rule, or what she will ask the General Assembly to fund for enrollment help — items her campaign discussed, including a navigator program and money for county benefits offices, would require lawmakers to appropriate the money.
The deadlines do not wait for those decisions. The work requirement and the six-month renewal cycle are law on Jan. 1, whoever is governor. Acton takes the oath on Jan. 11 with the first renewal wave already building — and with roughly 154,000 Ohioans whose coverage depends on how the system her administration runs handles their cases.
