07/16/2026

Medicaid Posts July 1 Rates

This week, the Ohio Department of Medicaid (ODM) posted July reimbursement rates to its website. These rates reflect updated quality incentive payment scores, as well as the proportion of the case mix index that is derived from PDPM data. Notably: 

• The 25th percentile threshold for quality incentive payments increased to 35.75 points, out of a total range of up to 49.5 points. 
• The price per quality point is set to $1.03.
• Beginning 7/1/2026, two-thirds of the case mix score is derived from PDPM scoring, adjusted for budget neutrality. 

Members are encouraged to review rates to ensure they align with internal data tracking. Providers may request a rate reconsideration if they believe there were errors made in Medicaid’s calculations. Questions may be directed to Stephanie DeWees at sdewees@leadingageohio.org or Susan Wallace at swallace@leadingageohio.org.