Medicaid Silent on Rate-Setting, Back Payments

As the February billing cycle approaches, Ohio nursing homes have still not received reimbursement rates effective January 1, heightening anxiety about their ability to conduct business and fund ongoing operations.

The Ohio Department of Medicaid has continued to delay the release of the January 1 rates reflecting the appropriate Quality Incentive Payment (QIP) levels, as required under the Ohio Supreme Court’s decision affirming the correct interpretation of the FY 2024–25 operating budget language and directing the department to recalculate rates. As mentioned during January’s Advocacy in Action call, LeadingAge Ohio has communicated with the department on multiple occasions regarding the release of these rates and will continue to press for their issuance.

The department has also remained guarded in its communications regarding back payments to nursing home operators. While the Supreme Court’s ruling on the mandamus action affirmed the rate interpretation and recalculation, it was silent on the issuance of retroactive payments, leaving that issue to individual providers and lower courts. It has been our hope that the department would act in good faith to prevent legal action by hundreds of Ohio nursing homes, but as delays persist, that hope diminishes.

In coordination with its Board of Directors, LeadingAge Ohio is planning future steps should these delays continue into February. These include:

• Advocacy education for members, so that they may reach out directly to their legislative representatives. LeadingAge Ohio shared talking points this autumn for the mandamus action, and encourages members to apprise their state legislators of the ongoing delays in rate packages.  
• Education on legal remedies available to providers who are looking to recoup damages from the unpaid quality incentive payments.  
• A toolkit including Q&As, tips for communicating with boards and other resources to support members’ decision making. 

LeadingAge Ohio values productive and constructive conversations with the Ohio Department of Medicaid, and the department is aware that we welcome dialogue on both issues. Our members prioritize providing high-quality care to residents every day, and the reimbursement promised by the legislature is essential to sustaining that care. LeadingAge Ohio remains committed to advocating for members and their residents by serving as the trusted expert and voice for quality nursing home care in Ohio.

Thank you for all that you do. We will continue to keep you informed as this situation develops.