by Bruce Checefsky

   (Plain Press October 2026) “Many changes are coming down the pike,” said Christy Nicholls at the Cuyahoga Job and Family Services Long Term Care Forum last month, referring to changes under United States Congress’ House Resolution (HR) 1, also known as the One Big Beautiful Bill Act (OBBBA). “We are taking these changes very seriously.”

   Nicholls, Deputy Administrator of Medicaid for Cuyahoga Job and Family Services (CJFS) in Ohio, oversees the county’s public healthcare assistance and support programs. CJFS, a County division, helps families and individuals access public benefits, jobs, and community services to promote economic self-sufficiency.

   Erin Bradford-Davis, manager of the Specialized Medicaid Benefits Center (SMBC), and Mayra Vargas-Bremer, SMBC Team Coordinator, were on hand to present material and new information regarding changes to the Medicaid program. SMBC is a service unit within the Cuyahoga County Division of Job and Family Services in Ohio, which administers, reviews, and determines eligibility for specialized, long-term care Medicaid programs and waivers.

   Medicaid changes under the OBBBA begin in October for non-citizens. For most non-exempt Medicaid expansion adults, major changes will take effect Jan. 1, 2027. The changes include new eligibility categories and revised terminology and application language for non-citizen Medicaid eligibility, Nicholls said.

   “A five-year waiting period is imposed on most non-resident applicants with a green card before becoming eligible for Medicaid,” she said. “Exceptions to the waiting period include active military members, their spouses or unmarried dependent children of veterans, and serving spouses of veterans.”

   Work and eligibility requirements for non-exempt Medicaid expansion adults aged 19 to 64 include at least 80 hours per month of work or community engagement to keep their health coverage. To maintain eligibility their adjusted gross income must be at or below 138% of the Federal Poverty Level (FPL), and applicants must not be eligible for Medicare benefits.

   “Work requirements include paid or unpaid, in-kind work, or earning the federal minimum wage for eighty hours, which equals $580 a month,” explained Nicholls. “Community service with a public or non-profit organization counts towards the new requirement, or enrollment in an education program half-time can be counted as a work requirement.”

   Exclusions and exceptions include a parent, guardian, or caretaker relative of a family member, dependent children under the age of fourteen, disabled individuals, foster youth under twenty-six years old, disabled veterans, individuals participating in a drug or alcohol treatment program, incarcerated or recently released from incarceration within the last 90 days, and those with a health condition that prevents them from working.

   “This would include blindness or disability as defined by the Social Security Administration,” she added. “Anyone with a substance use disorder, disabling mental disorder, physical or intellectual developmental disability, or serious or complex medical condition is also exempt. Nursing home residents often meet one of these exemptions.”

   Under the new restrictions in HB 1, Medicaid enrollees will undergo eligibility reviews every six months instead of annually, requiring them to certify twice as often. Critics, including the Center on Budget and Policy Priorities (CBPP), a Washington, D.C.-based nonprofit research and policy institute, say more frequent reviews increase the risk that eligible people will “fall through the cracks” because of missed mail, address changes or complex paperwork.

   “The law cuts $1.1 trillion from Medicaid and Affordable Care Act (ACA) marketplaces, according to Congressional Budget Office estimates,” said CBPP. “Major cuts include a provision that takes away Medicaid from people who are eligible for the ACA Medicaid expansion but can’t show that they meet a work requirement, other red tape that will block people from enrolling in health coverage they are eligible for, and provisions that take away health coverage, across all major programs, from most categories of immigrants living lawfully in the U.S.”

   More than 100,000 Ohioans, including over 50,000 children, have lost Supplemental Nutrition Assistance Program (SNAP) benefits under President Donald Trump’s bill, which the Ohio Capital Journal reported would make the largest cuts to food stamps in the program’s history.

   As of May 2026, approximately 66.4 million people are enrolled in Medicaid across the United States, with an additional 7.1 million enrolled in the Children’s Health Insurance Program (CHIP), totaling roughly 73.5 million people combined.

   In Ohio, Medicaid and CHIP enrollment accounts for roughly 25% of the population, or about 2.6 million residents, a share that exceeds the national average. Ohio also ranks sixth nationally in total Medicaid spending. In Cleveland, an estimated 40% to 45% of residents—roughly 145,000 to 162,000 people—rely on Medicaid.

   Several nonpartisan organizations estimate that the new restrictions could cause 5 million to 15 million Americans to lose their Medicaid coverage beginning in 2026.

   The One Big Beautiful Bill Act (OBBBA), the legislative cornerstone of Trump’s second-term economic agenda, bundles permanent extensions of his 2017 tax cuts with new temporary deductions, border security funding, and extensive cuts to federal social safety net programs to offset the costs. Republicans view changes and cuts to Medicaid as necessary, claiming the program is too expensive and the welfare system is bloated, according to POLITICO, a global, nonpartisan digital news and journalism organization, even while most Americans favor keeping or increasing Medicaid funding because they or their families rely on it.

   In Cuyahoga County alone, over 87,000 Medicaid recipients who enrolled through the Affordable Care Act (ACA) expansion face new eligibility and work requirements, or roughly a third of the county’s 344,000 total Medicaid enrollees. Based on current projections, SMBC estimates 20,000 to 45,000 individuals will have to meet the new requirements or face losing coverage under new federal eligibility restrictions.

   Ohio’s Republican members of the U.S. House of Representatives who voted for OBBBA include David Taylor, Jim Jordan, Bob Latta, Michael Rulli, Max Miller, Warren Davidson, Mike Turner, Troy Balderson, David Joyce, and Mike Carey. All 10 are seeking reelection in the November 3, 2026, general election. Vice President JD Vance championed and supported the legislation. He cast a tie-breaking vote.

   The SMBC contact center is facing a surge in calls as the deadline nears but has been unable to add staff to meet demand, Nicholls said.

   “We apologize for the long wait times and encourage people to use the call-back line, which typically returns calls the same day,” she said. “However, depending on the volume of calls, the call-back may occur the following day.”

   As the 90-minute online forum ended, Nicholls said, “We are navigating changes that affect us all, and we are here to serve you.”

   To apply for Supplemental Nutrition Assistance Program (SNAP), Medicaid, Child Care or Cash Assistance, call 216-802-2810, email CuyahogaCustomerRelations@ifs.ohio.gov, or checkout the website at https://hhs.cuyahogacounty.gov.

   Staff addresses escalated issues within 48-hours of initial request and informs customers of next steps after consulting with eligibility staff. Provide name, address, home or cell number, or other contact information where customer can be reached.

   For additional support and information contact Erin Bradford-Davis, SMBC Center Manager, erin.Bradford-Davis@jfs.ohio.gov; Mayra Vargas-Bremer, SMBC Team Coordinator, mayralie.Vargas-Bremer@jfs.ohio.gov; and Christy Nicholls, Deputy Administrator, Medicaid, christy.Nicholls@jfs.ohio.gov.