H.R. 1 and New Ohio Medicaid Work Requirements

The changes apply only to people enrolled in Group VIII (Group 8). This generally means adults ages 19 through 64 who have Medicaid because their income is at or below 138% of the federal poverty level.

To check your coverage group:

• Sign in to the Ohio Benefits Self-Service Portal at benefits.ohio.gov.
• Go to View My Benefits.
• Or look at a recent notice from the Ohio Department of Medicaid.

Some people in Group VIII (Group 8) are exempt from the work requirement. Ohio will first try to use information it already has to verify whether you are exempt or meeting the requirement. If more information is needed, you will receive a notice.

Starting January 1, 2027, you may need to complete at least 80 hours each month of one or more approved activities. These can include:

• Working for pay or being self-employed.
• Doing unpaid work, such as caregiving, an internship, or work in exchange for goods or housing.
• Volunteering through an organization, government agency, or religious group that helps the community and is not for a political purpose.
• Taking part in a recognized work program, including programs through OhioMeansJobs.
• Going to high school, a GED course, college, or technical school at least half-time.
• Using a combination of approved activities for a total of at least 80 hours in the month.

You may also meet the requirement if your monthly income is at least $580 before taxes. Special rules apply to seasonal workers.

Keep records in case Ohio Medicaid asks for proof

Examples of proof include paycheck stubs, a letter from an employer, self-employment tax records or a ledger, a letter showing volunteer or work-program hours, school enrollment records, or a class schedule.

You may be exempt

You may not have to meet the work requirement if an exemption applies. Examples include pregnancy or postpartum coverage, certain health conditions or disabilities, caring for a child age 13 or younger or a disabled person, qualifying foster care status, qualifying Native American status, total veteran disability, certain TANF or SNAP participation, drug or alcohol treatment, recent release from incarceration, or Medicare Part A or Part B status.

Ohio decides whether an exemption applies. Keep documents that may help show your exemption. These may include a doctor’s statement, disability award letter, birth certificate, custody record, Medicare card, treatment-program statement, tribal identification card, or proof of release from incarceration.

Even if you are not required to work, go to school, or volunteer under the new rule, you may still need to renew your Medicaid coverage. Ohio will let you know when it is time to renew. Most Medicaid members who are not in Group VIII (Group 8) need to renew their coverage once a year.

If you are told that you must meet the work requirement and you think that is wrong, contact the Ohio Medicaid Consumer Hotline at 1-800-324-8680.

Starting January 1, 2027, Group VIII (Group 8) members will renew Medicaid coverage every six months instead of every 12 months. At renewal, you must show that you were exempt or met the work requirement for at least one month since your last application or renewal.

Example: If your last renewal was in January and you renew again in July, you must show that you were exempt or met the work requirement for at least one month between January and July. You do not have to prove compliance for all six months.

• Keep your home address, email address, and phone number current with Ohio Medicaid.
• Read mail, email, and text messages about your Medicaid coverage.
• Report changes within 10 days. Tell your county Job and Family Services office if your income, job, address, household members, or pregnancy status changes. If you may be affected, keep records of work, school, training, volunteer, or other approved activities.
• Keep documents that may show you qualify for an exemption.
• Respond by the deadline if Ohio asks you for information.

• Upload information through the Ohio Benefits Self-Service Portal at benefits.ohio.gov.
• Mail or take documents to your county Job and Family Services office. County locations are available at benefits.ohio.gov.
• Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or call your county Job and Family Services office.

Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or visit Ohio Medicaid Work and Community Engagement.

Respond quickly to keep your benefits!

• You must complete and return your review form for the chance to be determined eligible for another year of Medicaid coverage.
• If you return your completed form on time and are still eligible for Medicaid, you will continue receiving AmeriHealth Caritas Ohio benefits without interruption.

You are important to us! We want to help you get and stay healthy and continue enjoying your AmeriHealth Caritas Ohio exclusive benefits. (Note: Your health plan choice does not affect your Medicaid eligibility.)

Renew today and choose AmeriHealth Caritas Ohio. We’ve got you covered.

Your annual review process: Easy as 1, 2, 3!

Step 1: Your local County Department of Job and Family Services (CDJFS) recently mailed you an Annual Review Form in an envelope.

• If you have the form, please fill it out completely and go to step 2.
• If you are unable to locate the form, Medicaid members are strongly encouraged to create an Ohio Benefits Self-Service Portal (SSP) account as soon as possible. This is the most convenient way to complete a renewal or report any changes to your information. Through your SSP account, you can also easily check the status of your benefits.

Step 2: When completing the form, you will need to include the following:

• Your Medicaid ID number.
• Proof of income (include all that apply):
  • Copies of pay stubs for the last four weeks or a letter from your job(s) that shows your last four weeks of total pay.
  • A copy of the letter telling you the total amount of any benefits you got through Social Security, unemployment, Veterans Affairs, workers’ compensation, and other sources.
  • Proof of all other income for the last four weeks. This includes child support.
  • If you are self-employed, attach a copy of your most recent federal income tax form, including all schedules.
• A statement or receipt of your payments to a day care provider (child or adult day care).
• Any other documents requested in the renewal packet.

Step 3: Return the form and documents:

• Fastest way to renew! Ohio Medicaid members can find their CDJFS online by selecting their county from the drop-down menu at Ohio Medicaid: Select County.
• Get in-person help at your local CDJFS office.
• Mail your form and documents to your local CDJFS office.
• Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680.

AmeriHealth Caritas Ohio cares about your well-being.

Did you receive your redetermination form and need help with the renewal process? Call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).

If you do not speak English, language assistance services, free of charge, are available to you. Call 1-833-764-7700 (TTY 1-833-889-6446).

Atención: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-833-764-7700 (TTY 1-833-889-6446).

You may be able to buy low-cost health coverage through the federally facilitated Marketplace at HealthCare.gov. If you need help understanding your options, trained, licensed healthcare Navigators are available at no cost to you. Contact Get Covered Ohio for free, unbiased assistance. Go to Get Covered Ohio or call 1-833-628-4467. Navigators can help in person, online, or over the phone.

Providers and community partners are trusted messengers. You can help patients and community members avoid unnecessary loss of coverage by sharing clear, accurate information.

• Remind people that the new work and six-month renewal rules apply only to Group VIII members.
• Encourage members to check their coverage group in the Ohio Benefits Self-Service Portal or on a recent Ohio Medicaid notice.
• Remind members to keep their contact information current and to respond to requests from Ohio Medicaid or their county Job and Family Services office.
• Tell members that Ohio, not the provider or AmeriHealth Caritas Ohio, determines Medicaid eligibility, exemptions, and compliance.
• When clinically appropriate, provide requested medical documentation that may help Ohio evaluate a medical-frailty exemption.
• Direct eligibility questions to the Ohio Medicaid Consumer Hotline at 1-800-324-8680.