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There is a great deal going on with Medicaid both on the Federal level and in the State of Ohio. We want to make certain that all Ohio “Medicaid School Program” (MSP) participating school districts understand and are prepared for upcoming changes to MSP. We will be informing you of these changes as the Ohio Department of Medicaid (ODM) and the Ohio Department of Education & Workforce (ODEW) release final details. This “Ohio Medicaid School Program Bulletin” HBS 2025-1 is the first in a series of Ohio MSP related bulletins that we will be releasing during the year.

This edition’s topic is about Ohio Medicaid Expansion.

Ohio Medicaid Expansion can be a confusing topic, as this term is currently used in two different contexts in Ohio. There is the Medicaid Expansion that the John Kasich administration put in place in 2013, (referred to as ACA Expansion Medicaid), and there is the Ohio “Medicaid School Program” Medicaid Expansion that ODM and ODEW are currently working on.

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2013 “Affordable Care Act” Medicaid Expansion

Prior to 2013, Ohio had two different Medicaid eligibility categories. One was “Regular Medicaid” and the second was “Healthy Start Medicaid”. The 2013 Medicaid Expansion added a third category of Medicaid called “ACA Expansion Medicaid”. Each of the three categories have different eligibility criteria and the Federal Medicaid Assistance Percentages (FMAP) are different for each category of Medicaid. For Federal Fiscal Year 2026, Regular Medicaid reimburses the State at 64.85%, Healthy Start Medicaid at 75.40%, and ACA Expanded Medicaid is reimbursed at 90%. To date, we have not seen any school aged children enrolled under ACA Expanded Medicaid.

The current Federal Administration has threatened to cut the ACA reimbursement percentage from 90% to the Regular Medicaid percentage of 64.85%, which would require Ohio to cover 25% more of the costs of ACA Expanded Medicaid. Governor DeWine has stated that Ohio will pull out of the ACA Medicaid Expansion if the FMAP is reduced by the Feds. Since no students are currently covered under ACA Medicaid, this would have no effect on Ohio Medicaid School Program reimbursement.

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Ohio “Medicaid School Program” Expansion

Over 25 States have expanded their “School Based” Medicaid programs to allow for reimbursement for non-IEP services such as 504 Plans, Behavioral Plans, Stand-alone Nursing Care Plans, and other Health Care Plans of Care. Ohio is in the final stages of unveiling it’s plan for MSP Medicaid Expansion with a possible start date of the 2025/26 school year. A few new services and provider types will also be added to Ohio MSP. We will communicate the details in an upcoming MSP Bulletin as soon as final details are released, and subsequent Bulletins will cover implementation and compliance. 

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If you have any questions or need further information on any of our Ohio MSP Bulletins, please contact our office at (740) 639-4218 or email at Info@teamhbs.com.

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