Going through all the eligibility criteria also can be humiliating for the people who are seeking coverage, said Ohio Medicaid director John McCarthy.

"The person does not have a lot of money," McCarthy said in an interview Wednesday. "Making somebody go through a long, complex process — digging into your life and having to bring in a bunch of paperwork; … it's time-consuming and complicated. So why are we putting up all these barriers?"

The hurdles can lead people to never finish the application process, he said. Then they don't get the medical care that they need — and for which they are likely eligible.

"That ultimately costs the state much more money, as opposed to if we could have gotten them into the program, gotten them the services," McCarthy said. "We could have improved health outcomes."

The state wants to move away from what officials call a fragmented eligibility process, to a model that's more streamlined and based on income.

"That captures the bulk of everybody on Medicaid," said Greg Moody, director of the governor's office on health care transformation, in a recent interview.

The proposed changes were posted online Wednesday for public comment, and the state plans to hold open meetings on the draft. Officials will submit the proposal to the federal government for approval next month. They want the changes to take effect by 2014.

McCarthy said the state's goal is not to drop anyone from Medicaid as a result of the changes.

Officials have asked the federal government for permission to keep people in the program who meet current eligibility standards until they no longer meet their previous qualifying criteria, obtain other coverage or withdraw from the program.

"We are not trying to have fewer people in the program," McCarthy said.

To accommodate the eligibility changes, health officials are seeking federal support to help replace a more than 30-year-old computer system that frequently erroneously denies Medicaid eligibility and causes a huge administrative burden.

"The system is so old that the county case workers have to go in and modify the answer based on information they know, but that the system can't accept," Moody said.

The automated system rejects 60 percent of people who are really eligible, he said.

McCarthy said he doesn't expect the eligibility changes to save the state money in terms of medical services used under Medicaid. But he said there would be administrative cost-savings because of the technology upgrade and streamlined process.