Medicaid freeze on CHIP projects could impact Ohio children’s enrollment
State officials not sure how program reductions will get implemented
By Susan Tebben
Ohio Capital Journal
COLUMBUS — The recent federal announcement of a freeze on projects that help states use their Medicaid programs to suit the needs of their residents could have an impact on future projects in Ohio.
In the most recent state budget, one such project was nearly taken off the table, one that would ask the federal government to authorize continuous enrollment for Medicaid-eligible children younger than age three.
The federal Social Security Act allows the U.S. Secretary of Health and Human Services to approve pilot projects, also called “demonstrations,” to give each state individual discretion to tailor the Medicaid program to the residents’ needs.
“These demonstrations give states additional flexibility to design and improve their Medicaid programs, and to demonstrate and evaluate state-specific policy approaches to better serve Medicaid beneficiaries,” according to a July 17 letter signed by Drew Snyder, listed as deputy administrator and director for the U.S. Center for Medicaid & CHIP Services.
CHIP is the Children’s Health Insurance Program which can provide coverage through Medicaid and through separate CHIP programs in some states.
That letter served as notification to states that the federal agency would be putting potential new pilot programs on hold in an effort to save money.
“This shift in approach reflects the agency’s commitment to preserving these vital programs for the most vulnerable Americans and being good stewards of taxpayer dollars,” the letter stated.
What’s missing?
As of Jan. 1, 2024, federal law required states to provide a year’s worth of continuous eligibility for children younger than 19 in both Medicaid and CHIP, whether or not their eligibility had changed in that time.
The American Rescue Plan also created an option for states to allow Medicaid and CHIP participants 12 months of continuous eligibility for “extended postpartum coverage.”
According to federal data, 242,625 children were enrolled in CHIP as of March 2025. More than 1.2 million children in Ohio are enrolled in both Medicaid and CHIP.
Because the pilot programs that some states, including Ohio, have requested approval for can expand eligibility “to additional populations as well as to increase the length of time that individuals could stay enrolled in Medicaid or CHIP,” the department said there were “concerns about the appropriateness” of continuing such pilot programs.
“By keeping potentially otherwise ineligible individuals enrolled in Medicaid or CHIP, this expanded continuous eligibility could lead to increased costs to states and the federal government,” the letter to states read.
The federal Medicaid program as a whole is preparing for cuts due to passage of the federal reconciliation bill just signed by President Donald Trump earlier this month.
The overall Medicaid cuts will impact Ohioans young and old who rely on the program for their health insurance.
In addition to the letter, the Center for Medicaid and CHIP Services said it would conduct “direct outreach to states with existing expanded continuous eligibility authority to emphasize that this authority is time-limited.”
The Ohio Department of Medicaid’s website notes that CHIP is operated as an expansion of the state’s Medicaid plan, rather than as a separate entity.
Ohio’s Medicaid program currently covers 2 in 5 children ages 18 and younger, with more than 375,000 children ages 0 to 5 enrolled, according to analysis by the Center for Community Solutions using data from March 2025.
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Known unknowns
While a spokesperson for the Ohio Department of Medicaid said the agency “does not currently have programs related to (The Center for Medicare & Medicaid Services’) recent communications regarding continuous eligibility,” the ODM and Gov. Mike DeWine’s administration “are working with partners including CMS to align with federal requirements.”
“ODM is still assessing the impact of these changes,” said Stephanie O’Grady, deputy director and chief communications officer at the department, in a statement.
The state has applied for various types of waivers through the Social Security Act’s pilot project authority over the years, including one to include a “pre-enrollment requirement” to the state’s Medicaid expansion group.
That request is still pending, according to a U.S. Department of Medicare & Medicaid Services database.
Another such waiver request was for “multi-year continuous eligibility for children,” in which the state Medicaid department requested the move to comply with the previous General Assembly’s budget bill.
The budget required the state agency to “provide continuous Medicaid enrollment for children from birth through three years of age,” according to the waiver application.
“Preventive care, treatment for physical and behavioral health conditions and early childhood screenings are essential to setting children up for success and building a foundation to support their health and well-being through the rest of their lives,” the application stated.
The Health Policy Institute of Ohio said research showed between 2022 and 2023, 14.4% of Ohio children ages 0 to 5 did not have a preventative care visit over the course of the year.
The pilot program proposed by the state would last from Oct. 2025 through Sept. 2030, and allow certain children in that age group who are eligible for Medicaid to remain eligible for 48 months or until the end of the month in which they turn four, whichever comes first.
The state Medicaid department said goals of the pilot program would be to minimize coverage gaps to allow for consistent care and screenings, decrease the need for “higher-cost services associated with delaying care” and “easing the stress and burden on families and caregivers as they navigate Medicaid coverage,” along with reducing administrative costs.
In the most recent state operating budget, legislators tried to eliminate that provision within state law that required the Medicaid department to ask for the continuous enrollment waiver.
Gov. Mike DeWine vetoed the move at the end of June as he finalized the state operating budget for the next two years, keeping the requirement in place.
The federal decision to hold off on the projects like the state’s continuous enrollment proposal could mean long term issues, particularly for already struggling households.
“This waiver offered the potential to help alleviate existing gaps in care access for young children in Ohio, which can improve health and prevent illness later in life,” Brian O’Rourke, a health care policy analyst with the Health Policy Institute of Ohio, told the Capital Journal. “With the recently announced plan by CMS to deny these waivers, these access issues will likely persist and potentially even grow over time, especially for low-income families.”
Susan Tebben is an award-winning journalist with a decade of experience covering Ohio news, including courts and crime, Appalachian social issues, government, education, diversity and culture. She has worked for The Newark Advocate, The Glasgow (KY) Daily Times, The Athens Messenger, and WOUB Public Media. She has also had work featured on National Public Radio.
Ohio Capital Journal is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
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