By: Brandy Davis, Fellow, Medicaid Policy
and Grace Powers, Policy Intern
House Bill 96 (H.B. 96), as enacted by the 136th General Assembly, contains provisions that affect everything from Medicaid eligibility to payment structures to oversight and healthcare services. We'll walk through some of the major Medicaid and health related provisions highlighting some impacts, some fiscal effects and broader implications for the Ohio Department of Medicaid (ODM) providers, and ultimately, patients.
Increased verifications
Now, ODM must use third-party data sources to verify eligibility. These practices aim to increase accuracy and while this practice was already occurring, further checks may also increase bureaucracy.
H.B. 96 also eliminates the requirement for individuals with incomes above 150% of the federal poverty level to pay premiums under the Medicaid buy in for workers with disabilities program.
Workers with disabilities
H.B. 96 also eliminates the requirement for individuals with incomes above 150% of the federal poverty level to pay premiums under the Medicaid buy in for workers with disabilities program. This eases access to Medicaid for working people with disabilities although ODM will lose associated premium revenue throughout this process. The net effect is essentially an increase in program accessibility which reinforces employment incentives for Ohioans living with disabilities.
Nursing facility rates and patient driven payment model
The budget bill includes an increase in access to a phased in program for the patient driven payment model where calculations for nursing facilities direct care rates will gradually shift beginning in fiscal year 2026. ODM must submit quarterly progress reports, and the transition is intended to be budget neutral.
Managed care oversight
ODM now must expand its financial dashboard to include actuarial metrics and per-member-per-month (PMPM) service reports.
The implementation of this measure aims to increase transparency for lawmakers and the public.
As it relates to increasing data transparency, ODM must also improve MCO data cross-checking with other state and federal databases.
Children’s hospitals
As it relates to prioritizing funds, there is an earmark for lodging services for children’s hospitals to reduce financial impacts on families of children with increased health needs.
Ultimately, H.B. 96 incorporates a blend of eligibility checks and oversight measures that could potentially reshape Medicaid in Ohio.
Programmatic changes
Those who are found to have committed Medicaid fraud have mandated penalties of restitution up to 200 percent of the amount paid for claims found due to fraudulent Medicaid eligibility.
And ODM must also report errors relative to presumptive Medicaid eligibility.
Diversity, Equity, and Inclusion is also prohibited, though there are limitations for disability-related services.
Additionally, to the extent allowed by federal law, ODM is unable to use Medicaid funds that cover gender affirming care.
Ultimately, H.B. 96 incorporates a blend of eligibility checks and oversight measures that could potentially reshape Medicaid in Ohio.
Trigger language
Currently, the Federal Medical Assistance Percentage (FMAP) is set to cover 90% of the cost of individuals in Group VIII or the Medicaid expansion population. H.B. 96 includes a provision that if the FMAP is set below 90% for Group VIII, then the Ohio Department of Medicaid (ODM) will be mandated to create a plan to transition individuals who are no longer eligible to private insurance or charity care.
2026 and 2027 appropriations
Below are the future appropriations fiscal years (FY) 2026 and FY 2027, along with the actual budgeted amounts for FY 2024-2025.
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