Fueled by the bi3 Fund, Health Policity Institute Ohio (HPIO) has launched an expansive study on the potential impacts of eliminating Medicaid expansion in Ohio.
Since Ohio expanded Medicaid eligibility in 2014, hundreds of thousands of residents with lower incomes—including working people, parents, grandparents, veterans, and caregivers—have gained access to medically necessary health care. As of March 2025, nearly 770,000 Ohioans are covered through Medicaid expansion.
This HPIO brief—the first in the 2025 Ohio Medicaid Expansion Study series—describes the role of Medicaid as a funder of mental health and substance use disorder services and highlights considerations for how working-age Ohioans with low incomes would access behavioral health care if expansion coverage was eliminated.
Key findings
- High demand: Many Ohioans enrolled in Medicaid have behavioral health conditions. Forty percent of adults covered by expansion had a primary mental health and/or substance use disorder diagnosis in 2024.
- Significant investments: Ohio received $1.6 billion in federal funds for community-based and hospital behavioral health services for expansion enrollees in calendar year 2024.
- Potential risk: If expansion were discontinued, many Ohioans would lose access to treatment. Policy priorities such as improving supports for recovery and re-entry and suicide prevention could be curtailed.
