The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
People pushing cuts to the safety net in Ohio and nationally say they want to stop freeloading and waste. Ohioan Tarrezz Thompson does everything those people say they want.
She owns a small business, teaching small children with learning disabilities who mostly come from low-income families. She’s helping herself and her family by giving those kids and their families a hand up.
But Thompson, a mother of six and the recipient of a kidney transplant, said maintaining health and other benefits is a confusing, arbitrary process already.
She warns that with budget cuts and new state and federal work requirements, many families will be forced from the system — not because they don’t want to work, but because the hassle will make maintaining benefits virtually impossible.
And that, she said, will only compound the problems that drove people to need help in the first place.
Thompson, who works with the Ohio Organizing Collaborative’s Care Economy Project, said that the families she works with have a take-what-comes attitude, but many don’t appreciate what’s about to hit.
“Most families are aware of what’s coming down the pike,” she said. “They’re operating out of their own post-covid trauma and they’re like, ‘we’ll figure it out when we get there.’ I tell them, you aren’t in a position to provide medical care for your children. That’s a lot of money. Without insurance, it’s even more.”
Disruption
President Donald Trump’s One Big Beautiful Bill Act will slash nearly $1 trillion in Medicaid spending over 10 years. Those cuts include about $33 billion in Ohio, according to estimates KFF released late last month. It will slash another $230 billion in federal food assistance over the same period.
KFF estimates that most of Medicaid savings will be achieved through attrition caused by work requirements.
Those rules will take effect at the start of 2027. Many of the SNAP work requirements took effect the day Trump signed the bill.
While making unprecedented cuts to programs for the poorest Americans, the law gives $1 trillion in tax cuts to the richest 1%. It also balloons the deficit by $3.4 trillion, according to the nonpartisan Congressional Budget Office.
In Ohio, Gov. Mike DeWine has requested permission from federal authorities to impose state work requirements on the 770,000 residents who are enrolled as part of the expansion of Medicaid under the Affordable Care Act. The feds haven’t ruled on that request.
The work requirements come even though 92% of non-disabled Medicaid recipients under 65 are either working, or couldn’t due to caregiving responsibilities, or were ill, or in school.
They also come despite the fact that work requirements implemented in Arkansas in 2018 increased the number of the uninsured, while having no effect on employment.
Real people
Thompson said it can be bewildering to try to work and maintain benefits even without the new requirements.
Her youngest child is disabled, and he and the rest of her kids who are still minors qualify for traditional Medicaid. But Thompson said she keeps getting bounced around between traditional Medicaid, the expansion group, and a changing methodology to consider her eligibility.
“What I’ve been experiencing this year is they keep moving me from what program is covering my Medicaid,” she said, explaining that in the past month alone, she received three notifications that she’d been moved from one program to another.
“I got moved from Medicaid to the Medicaid Adjusted Gross Income program. It’s supposed to be for individuals without children.”
The Morrow County Job and Family Services website gives a flavor of how hard to understand the rules can be when it tries to explain Medicaid Adjusted Gross Income Program, or MAGI, rules:
“Will MAGI rules apply to everyone seeking Medicaid coverage?” it asks in a Q&A.
“MAGI-Based Eligibility applies to individuals who are considered Covered Families and Children (CFC) Medicaid categories including families, children up to age 19, pregnant women, and adults 19 – 64 who are below 138% Federal Poverty Level (FPL),” it says. “MAGI rules also apply to time-limited coverage for individuals who were enrolled in Medicaid’s parent category and lost eligibility due to increased earnings or spousal support.”
What the many changes have meant for Thompson are doctor visits in which she thought she was covered, but then told that she was not.
She also needs to take prescription drugs and have regular lab work because of her kidney transplant. Repeated changes have resulted in coverage denials totaling about $1,000 that she can’t pay.
On top of being a mother and running a business on a shoestring, she has to deal with that as well.
“It’s a bureaucratic nightmare,” she said. “I don’t know that the changes happened. I go to my doctors. They tell me my coverage has ended and then I have to restart the cycle to find out how to get their services covered. I currently have four medical bills that I’m trying to resolve. They were actually covered, but when they submitted them, they got denied for non-coverage.”
Thompson has tried to get health coverage in the marketplace created by the Affordable Care Act, but she kept getting denied when it was determined that she was eligible for Medicaid.
“It’s pretty stressful,” said Thompson, whose calm outward demeanor belies her stress. “My cortisol level is really high.”
Double whammy, widespread pain
When the new bureaucracy and funding cuts kick in, Thompson is unlikely to get much relief.
She said she was worried about how the changes might affect her son, who starts college in the fall and will turn 18 just a month later. And she worries about how they would affect her business, because most of her students’ families are on Medicaid and other assistance as well.
“What’s scary to me is that all these changes in some way, shape, or form are going to touch me,” Thompson said.
When families lose housing, food assistance, or health care, they become destabilized, she said.
“What happens is they move wherever they need to go to get that stability,” she said. “Many families have moved out of my service zone or even out of the state, so I lose revenue. That puts my program in crisis mode because I still have to pay expenses to maintain the program.”
Thompson is far from alone.
In a state where more than 25% of people are on Medicaid, such destabilization threatens to become commonplace — or at least, more commonplace.
She described what happened to the family of one of her clients during the covid pandemic.
“There was a grandmother, a mother, three daughters, and an adopted child living in a house,” Thompson said. “The mother, the grandmother, and one of the daughters were working, and the mother was handling all of the bills.”
She fell behind on rent and got an eviction notice.
“They were scrambling to come up with $2,500 on a place that was costing them $500 a month,” Thompson said, explaining that the amounts might not seem like much, but for people in such situations, it’s an impossible amount.
