Senate Bill Limits Medicaid Growth,
Moves OHFA to Development

The Ohio Senate revealed its first round of changes to House Bill 96, the state operating budget the afternoon of June 3, 2025. Changes that will most directly impact LeadingAge Ohio members include:

• Long-term care
• Private Rooms: The House-added cap of 15,000 private rooms has been removed, and reverts to current law of a $160 million annual cap. Also removes the House-added requirement that private room utilization be reported to the Joint Medicaid Oversight Committee.
• PDPM: The bill retains the governor-proposed transition to PDPM case mix over three years, relying on only the nursing component. Notably absent is language which would make up for the difference between RUGS and case mix scores.
• Nursing Facility Dialysis Add-On: Retains the House-proposed $110 dialysis add-on payment.
• Personal Needs Allowance: Eliminates House-added language that reduced the personal needs allowance (PNA) from $100 per month to $75 per month. It is unclear whether this eliminates the PNA expansion outright, or simply reverts it to the executive proposal, which included no legislative language but did include funding to increase the PNA.
• Ombudsman: Retains a House cut to the Ombudsman Support Fund.

• Housing
• Ohio Housing Trust Fund (OHTF): The bill removes house-added changes to the OHTF that would have allowed counties to capture recorders’ funds rather than pooling statewide funding.
• Ohio Housing Finance Agency (OHFA): Moves OHFA under the Ohio Department of Development, eliminates the Agency’s Board of Directors, and vests the authority of the Agency’s Executive Director with the Director of Development.

• Home- and community-based services
• PACE: Related provisions added by the House (expansion, timeliness of services) have been removed. Ohio’s PACE advocates, including LeadingAge Ohio and its sister organization, the PACE Association of Ohio, have circulated corrective amendments to be included in the Senate omnibus amendment.
• Electronic Visit Verification: Removes provisions that would have established duties and requirements on establishing an EVV system under Medicaid
• A $1M per fiscal year earmark for the Ohio Council for Home Care and Hospice was eliminated.
• Direct Care: Expands the proposal to conduct annual evaluation of direct care worker wages, and report the data to the legislature and the governor.
• Senior Community Services: The House-added earmark of $150,000 in each fiscal year to the Senior Community Services line item to support the IConnect program was removed.
• The bill makes several changes to the law regarding pronouncement of death, which was included in neither earlier version of the bill. LeadingAge Ohio is evaluating the impact the changes may have on hospice and other aging services organizations and will include more details in this week’s edition of The Source.

Other changes that may have a less-direct impact on LeadingAge Ohio members include:

• Managed Care
• Medicaid Managed Care Financial Dashboard: Requires Medicaid to include both of the following on its managed care financial dashboard: (1) actuarial metrics for annual and quarterly cost reports for specified Medicaid eligibility populations, and (2) quarterly and annual composite per member per month category of service reports for specified services for each Medicaid MCO
• Managed Care Organizations: Removes provisions that would have specified that Medicaid must allow individuals to enroll in the Medicaid MCO plan of their choosing and required Medicaid to randomly assign an individual to a plan
• Integrated Care Delivery System: Removes provisions that would have required participants the choice to enroll in Medicare coordination only dual special needs plans and approve contracts with entities not selected to participate in the ICDS, known as MyCare Ohio, successor
• Medicaid (general)
• Medicaid Program Support: Restores the executive proposal for Medicaid Program Support line under ODJFS by $5 million each fiscal year, to be distributed based on performance criteria established by Medicaid, including timeliness and accuracy of application and renewal processing.
• Presumptive Eligibility: Removes provisions that would have required Medicaid to submit a waiver request to CMS to eliminate mandatory Medicaid hospital presumptive eligibility determinations to only pregnant women and children.
• Medicaid Reports on Fraud, Waste and Abuse: Adds a provision requiring reports regarding fraud, waste and abuse to be submitted to JMOC and the legislature.  
• JMOC Oversight: Requires the Department of Medicaid to notify the Joint Medicaid Oversight Committee when making amendments to waivers or state plans, or when significantly adjusting
• Pharmacy Benefit Managers: Removes House-proposed controls for pharmacy benefits managers (PBMs) and their interactions with Ohio pharmacies.

In a press conference following the Finance Committee hearing, Senate President Rob McColley highlighted the bill’s achievements, including tax relief: the bill flattens Ohio’s income tax and provides property tax relief. He also shared his concerns regarding growth in Ohio’s Medicaid program, noting the program has grown “well beyond the rate of inflation” in recent years.  Across human services agencies, the Senate pulled back modest expansions achieved in the House eliminated new programs and policies, opting to eliminate earmarks and reinforce the status quo.

Most concerning for LeadingAge Ohio is the Senate’s omission of language related to the transition to RUGS scores to PDPM scores.  Without adjustment, the PDPM-based case mix indices are significantly lower than RUGS-based indices and will result in a significant loss in funding. Other top concerns include dissolution of the Ohio Housing Finance Agency (OHFA) into the Department of Development, and the elimination of two PACE amendments, which though cost-saving, but could be misinterpreted as an expansion of the Medicaid program. LeadingAge Ohio plans to testify this Thursday to focus on these most-urgent issues, encouraging the Senate Finance Committee to include changes in their omnibus amendment. Amendments are due this Friday, June 6 at noon.

LeadingAge Ohio will include further detail on the budget bill in this week’s edition of The Source. Questions regarding the bill may be directed to Eli Faes at efaes@leadingageohio.org or Susan Wallace at swallace@leadingageohio.org.