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Ohio has 61 community health centers across 613 sites serving 1,011,546 patients — the #5 FQHC state by patients outside California and Texas. As an expansion state, Medicaid anchors the safety net, and H.R. 1 work requirements plus the December 2026 funding cliff are the key risks.
Ohio's ~59-60 FQHCs and look-alikes serve nearly one million patients across roughly 550 sites in 76 of 88 counties, with Medicaid covering about half of those patients — so the state is unusually exposed as Medicaid changes converge. Governor DeWine signed the FY2026-2027 budget (HB 96) on June 30, 2025, funding the OACHC-administered FQHC Primary Care Workforce Initiative and $20M for school-based health care, but the same period brought a state 1115 work-requirements waiver plus the federal H.R.1 (One Big Beautiful Bill) 80-hour work mandate, with analyses projecting roughly 330,000+ Ohioans losing Medicaid in year one. Layered on top is the December 31, 2026 federal Community Health Center Fund cliff, leaving Ohio centers planning workforce and capacity against deep coverage and revenue uncertainty.
Patient-weighted across the 60 centers with UDS 2024 data.
Ohio is a reduced-practice state: a certified nurse practitioner must enter a written Standard Care Arrangement with one or more collaborating physicians (or podiatrists) before practicing, and the NP's prescriptive authority cannot exceed that of the collaborating physician — per Ohio Revised Code §4723.431 and Ohio Administrative Code Rule 4723-8-04.
Medicaid community-engagement (work) requirements under CMS-2454-IFC (80 hrs/month, full implementation Jan 1, 2027) plus expiry of the enhanced ACA premium tax credits (end of 2025) threaten Ohio's expansion population and FQHC Medicaid revenue.
5 primary-sourced findings on Ohio FQHC policy and financing.
The Community Health Center Fund — the mandatory federal grant stream underpinning Section 330 health centers — is authorized only through December 31, 2026. The 2026 Consolidated Appropriations Act set CHCF mandatory funding at $4.6B for FY2026 (NACHC's largest increase in a decade), but the lack of multi-year reauthorization leaves Ohio's ~59-60 FQHCs facing the cliff with only short-term certainty, dampening long-term workforce and capacity commitments. Nationally, GW researchers estimate the cliff could cost 100,000+ jobs.
NACHC (National Association of Community Health Centers)The federal One Big Beautiful Bill Act (H.R.1), enacted July 2025, imposes a nationwide 80-hours/month work-and-community-engagement requirement on Medicaid expansion adults 19-64, with full enforcement required no later than January 1, 2027 — superseding Ohio's narrower state waiver. Modeling projects ~337,000 Ohioans (a 10.7% enrollment drop, range 261,000-412,000) losing Medicaid in year one and a $5.13B first-year Medicaid spending decline ($53.3B over a decade). For FQHCs — where Medicaid covers roughly half of patients — this threatens both patient coverage and a core revenue stream.
The Center for Community SolutionsOhio submitted a Group VIII Section 1115 demonstration waiver to CMS on February 28, 2025, to require Medicaid expansion adults (ages 19-54, at or below 138% FPL) to work, attend school/job training, or meet a narrow exemption (age 55+, addiction treatment, serious mental illness, or intensive health needs) to enroll or renew. Ohio's eligibility review begins January 2026; the Ohio Department of Medicaid estimates ~62,000 (about 61,826) enrollees would lose eligibility, while the Urban Institute estimates 200,000+. The waiver notably excludes common exemptions for homelessness, high-unemployment areas, and justice-involved individuals.
Manatt, Phelps & Phillips, LLPGov. DeWine signed HB 96, the FY2026-2027 biennial budget, on June 30, 2025. It directs funding to the Ohio Association of Community Health Centers (OACHC) to administer the FQHC Primary Care Workforce Initiative — providing clinical rotations for medical, dental, behavioral health, PA, and advanced-practice-nursing students through FQHCs — and allocates $20 million over the biennium for school-based health care. Total Medicaid funding is $46.12B (FY2026) and $48.77B (FY2027).
BMD LLC (analysis of Ohio HB 96)A George Washington University Geiger Gibson / RCHN factsheet (Jan 30, 2025) documents Medicaid as the largest payer and revenue source for Ohio's community health centers, which serve nearly one million patients statewide. Ohio CHCs serve 1 in 7 Medicaid beneficiaries, with Medicaid covering about 52% of their patients on average. Because health centers depend on Medicaid for a large share of operating revenue, the combination of work requirements and federal cuts directly threatens both patient coverage and the financial viability of Ohio's 550+ FQHC sites.
GW Geiger Gibson Program in Community HealthBy patients (HRSA UDS 2024). Tap for the full profile.
| Organization | Patients | Sites | Uninsured | Revenue (990) | District |
|---|---|---|---|---|---|
| Muskingum Valley Health Centers Malta | 73,803 | 18 | 3.25% | $60M | OH-12 |
| Health Partners of Western Ohio Lima | 63,676 | 51 | 16.3% | $71M | OH-04 |
| Healthsource of Ohio Inc. Loveland | 60,693 | 24 | 5.67% | $74M | OH-02 |
| City of Cincinnati Cincinnati | 45,123 | 22 | 31.33% | — | OH-01 |
| Butler County Community Health Consortium Hamilton | 41,575 | 19 | 21.33% | $43M | OH-08 |
| Hopewell Health Centers Inc. Chillicothe | 41,264 | 46 | 4.09% | $77M | OH-02 |
| Metrohealth System, the Cleveland · Look-Alike | 38,930 | 10 | 13.1% | — | OH-11 |
| Columbus Neighborhood Health Center, Inc. Columbus | 35,301 | 16 | 40.44% | $39M | OH-03 |
| Signature Health, Inc. Willoughby | 34,538 | 12 | 11.75% | $100M | OH-14 |
| Family Health Services of Darke County, Inc. Greenville | 27,486 | 8 | 3.85% | $44M | OH-08 |
2 hospital/university/county-operated: 2 county.
| District | Representative | Sites |
|---|---|---|
| OH-02 | David J. Taylor | 86 |
| OH-09 | Marcy Kaptur | 84 |
| OH-11 | Shontel M. Brown | 64 |
| OH-06 | Michael A. Rulli | 53 |
| OH-01 | Greg Landsman | 51 |
| OH-04 | Jim Jordan | 50 |
Ohio ranks #5 by FQHC patients and #2 by organization count among the 57 national-breadth states/territories (excludes California and Texas, which have dedicated dashboards). All 61 centers depend on the federal Community Health Center Fund, authorized only through December 31, 2026.
FQHC data from the HRSA bulk-sites file + UDS 2024 + IRS 990. State policy profile via NACHC/KFF/AANP. Intelligence items cite primary sources. Federal items apply to all states; state items are Ohio-only. Updated 2026-06-03.