09/11/2025
Special All-Member Call Recap: Ohio Supreme Court Decision on Medicaid Reimbursement
On today’s all-member call, LeadingAge Ohio provided an update on the Ohio Supreme Court’s ruling in our mandamus case concerning calculation of nursing facility quality-incentive payments.
On September 2, the Court granted a writ ordering the Ohio Department of Medicaid to recalculate the quality-incentive pool using the change in each facility’s rate for direct care costs—not merely the change in the statewide “price” factor—consistent with R.C. 5165.26(E)(1)(a). The unanimous decision was explained in a 16-page opinion from the Supreme Court of Ohio.
To equip our members for conversations they will inevitably have about this case, LeadingAge Ohio has prepared additional resources:
Key points for members to emphasize include:
- What the Court held: The Department must build the quality-incentive pool using 60 percent of the per-diem change in each facility’s rate for direct care costs (which reflects the price times the facility’s case-mix score), as required by R.C. 5165.26(E)(1)(a). The Court rejected use of only the change in the price factor.
For statutory context members can cite: the quality incentive payment framework, the calculation of payments, the capital cost rate, and the case-mix scores.
- Not moot: The Court denied the Department’s mootness argument and confirmed that the statutory formula remains in effect, so the calculation issue is a live controversy.
- Our posture: LeadingAge Ohio exhausted every other avenue before pursuing litigation, including multiple meetings with the Ohio Department of Medicaid, the Governor’s office, and legislators. Our association is not adversarial or litigious by nature; litigation was a last resort to secure adherence to law.
- How to frame it: This is about accuracy and fairness under the statute. The pool’s size must follow the formula the General Assembly enacted. Members can emphasize that this ruling supports predictable, lawful Medicaid funding while implementation details are addressed.
- Provider impact: Ohio’s nursing homes continue to serve with significant Medicaid operating losses; this case seeks proper application of the quality-incentive formula to support stability of care statewide. Members should avoid overstating organization-specific impacts until official recalculations are released.
Next steps include ongoing legal and policy work, engagement with key legislative leaders, and timely member updates via The Source and special alert emails. Further questions may be directed to Susan Wallace at swallace@leadingageohio.org.