Under Trump’s Big Beautiful Bill, Ohio to lose $33 billion for Medicaid; 340,000 to lose insurance, analysts say

By Jake Zuckerman / October 16, 2025

New research projects steep funding drops and hundreds of thousands losing health insurance in Ohio due to the GOP-backed health care law passed by Congress this summer. In Cuyahoga County, as many as 35,000 residents could lose coverage.

The Trump administration’s signature health care package is projected to slash $33 billion over the coming decade in federal funds otherwise earmarked for Ohio’s Medicaid program, according to new estimates. 

That’s a 13% cut against the current spending baseline for Medicaid, the publicly funded health insurance program for the poor and disabled. 

The new law – formally known as H.R. 1 and commonly referred to as the “One Big Beautiful Bill Act” – kicks in at full force in 2027. This sweeping spending bill is expected to purge 340,000 Ohioans from Medicaid, which covers more than 3 million residents in the state. That’s according to Jennifer Tolbert, director of state health policy and data for KFF, a health policy news outlet, who spoke at a panel event last Thursday hosted by the Health Policy Institute of Ohio. 

“Of those, 290,000 will lose coverage because of the Medicaid changes,” Tolbert said. 

Unless states are willing to raise taxes or take money from elsewhere in the budget, she said policy makers will have two options. 

They can cut reimbursement rates paid to providers, as North Carolina recently did. Or they can start cutting discretionary services states choose but aren’t forced by federal law to cover. In Ohio, those optional services include dental, vision, prescription, occupational therapy, ambulatory and other care.  

To drill down into state specific figures, researchers from Georgetown University took estimates from the Congressional Budget Office and state estimates from KFF, a health policy news outlet, to assess the impacts of H.R. 1. 

They found the bulk of the Medicaid cuts come in the form of a requirement that recipients aged 19 to 64 work or study for 80 hours per month and prove as much to the state every six months. The law allows exemptions for certain health care or child-related circumstances. 

However, Ohio enacted a slightly different Medicaid work requirement that could take effect before the federal one. Here, the work requirement applies only to Medicaid recipients until they turn 55. The discord in timing and shape of the policies will be sorted out by the Centers for Medicare and Medicaid Services in the coming months. 

Beyond the work requirements, the federal legislation ends Medicaid eligibility for legal refugees and asylees in the U.S.; increases the frequency of eligibility determinations, where the state can eject people from Medicaid coverage; and imposes new co-pays of up to $35 for those who earn up to 138% of the federal poverty line (about $22,000 per year for an individual). 

What does this mean for rural hospitals

In some poorer, rural areas in Ohio, hospitals are disproportionately dependent on reimbursements via Medicaid to stay afloat. Four Democratic senators, all of whom opposed the bill, listed hundreds of rural hospitals they said were at risk of closure under the bill, based on research from the University of North Carolina. Eleven of those hospitals are in Ohio. 

In response to this and pressure from the hospitals, Republicans added to the bill a $50 billion “rural health transformation fund.” But as Georgetown professor Adam Searing said, the money is a pittance compared to the $990 billion cut to Medicaid estimated under the bill.

Of the $50 billion, half of it is split evenly between all states, with the other half to be distributed by the head of the CMS. And of the money a state receives, providers (including hospitals) can only receive up to 15% of the money. 

“It is, in no way, a way to make up for the full amount of those cuts,” he said.