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On June 30, 2025, Governor DeWine signed into law House Bill 96 (HB 96), the state’s biennial operating budget for state fiscal years 2026-2027. The state operating budget is the largest vehicle for statutory and policy changes every two years. HB 96 includes provisions that directly impact healthcare providers in Ohio, including the following:

• Federal Medical Assistance Percentage for expansion eligibility group – O.R.C. 126.70
  • Automatically ends Medicaid expansion coverage if the Federal Medical Assistance Percentage (FMAP) falls below 90%. 

• Group VIII transition plan – O.R.C. 333.360
  • Requires the Ohio Department of Medicaid (ODM) “to establish a phased transition plan to assist individuals who are no longer Medicaid eligible by redirecting them to private insurance,” if the FMAP for the Medicaid expansion population (i.e., Medicaid Group VIII) is set below 90%.

• Social gender transitions – O.R.C. 333.13
  • “Prohibits Medicaid reimbursement for mental health services that promote or affirm social gender transition.”

• Diversity equity and inclusion – ORC 333.12
  • Prohibits Medicaid funds to be used for diversity, equity, and inclusion initiatives, but “excludes funds to provide access to . . . Medicaid recipients with intellectual and developmental disabilities.”

• Medicaid Group VIII eligibility redeterminations – O.R.C. 5163.11
  • “Requires ODM to conduct eligibility redeterminations for Group VIII [i.e., Medicaid expansion] enrollees every six months.”

• Definition of sexes – O.R.C. 05 (A)(7)
  • “Establishes state policy to recognize only two sexes, male and female, which ‘are not changeable and are grounded in fundamental and incontrovertible reality.’”

• Genetic services funds for abortion referral or counsel – O.R.C. 3701.511
  • Eliminates the availability of Ohio Department of Health (ODH) Genetic Services funds “to counsel or refer for abortion in the case of a medical emergency.”

• Abortion reporting changes – O.R.C. 3701.79, 2919.171
  • Requires the abortion report to be completed by an attending physician when an abortion is performed surgically or through abortion-inducing drugs. Also requires that the pregnant woman’s state of residence and her zip code be reported.
  • Requires a “monthly and annual reports filled by hospitals and include the total number of Ohio residents versus non-Ohio residents who have undergone an abortion.”
  • Requires ODH to create a dashboard for the abortion reports to be published monthly and to be categorized on a number of different demographics including Ohioans who have received an abortion, out-of-state individuals who have received an abortion, and age.

• Medical death certificate – O.R.C. 3705.16, 4731.22
  • “Clarifies that the coroner or medical examiner certifies a death when a decedent dies of criminal or other violent means, while an attending physician certifies the cause of death in all other circumstances.”
  • “Authorizes the physician who last examined or treated a decedent to certify the decedent’s cause of death and complete and sign the medical certificate of death, but only in the case of a decedent who did not have an attending physician in charge of a patient’s care for the illness or condition that resulted in the patient’s death.”
  • “Extends the timeline by which a medical certificate of death must be completed and signed, from 48 hours after death to 48 hours after notice of death.”
  • Revises existing law provisions that apply when a decedent’s cause of death remains pending.

• Inspection fees – facilities operated by medical practitioners – O.R.C. 3748.13
  • “Increases inspection fees for radiation-generating equipment used in facilities operated by medical practitioners or medical practitioner groups.”

• Health plan issuer payment method and disclosure requirements - O.R.C. 3901.3815
  • Requires "a health plan issuer to offer all reasonably available methods of payment to a health care provider."
  • Prohibits a health plan issuer from charging "a fee for delivering payment by check or electronic funds transfer, either directly or indirectly . . . in connection with the method of payment."
  • Requires health plan issuers to create a process for providers to opt out of payment by credit card and select another method of payment.
  • If a health plan issuer, in connection with any available method, has a fee, the issuer must notify the provider about the fee, disclose the amount of the fee, notify the provider to contact certain payment processing entities about other fees that may apply and provide instructions on how to select the payment method.
  • Requests from providers to change their payment method must implemented by the health plan issuer within thirty-one (31) business days. Health plan issuers cannot charge a provider a fee for changing the provider’s payment method.

• Summary suspensions - O.R.C. 4730.25, 4731.22, 4759.07, 4760.13, 4761.09, 4762.13, 4772.20, 4774.13, and 4778.14
  • Revises the law authorizing the State Medical Board of Ohio to issue summary suspensions against its license holders by:
    • “Eliminating provisions specifying that an order is not subject to suspension by a court before the State Medical Board of Ohio issues its final adjudicative order and, instead, specifies the following: (a) that a summary suspension is not a final appealable order and is not an adjudication that may be appealed under the Administrative Procedure Act and (b) that once a final adjudicative order has been issued, any party adversely affected by it may file an appeal in accordance with the requirements of the Administrative Procedure Act.”
    • “Eliminating provisions specifying that the period during which a summary suspension is in effect applies unless reversed on appeal.”

• Federally Qualified Health Center Primary care workforce initiative– O.R.C. 291.20
  • “Requires FQHC [Federally Qualified Health Center] Primary Care Workforce Initiative, to be provided to the Ohio Association of Community Health Centers to administer the FQHC Primary Care Workforce Initiative.” The initiative is required “to provide medical, dental, behavioral health, physician assistant, and advanced practice nursing students with clinical rotations through” FQHCs. 

• MyCare Ohio expansion – O.R.C. 333.250, 5164.91, 5167.01, 5167.03
  • Allows for the continued expansion of MyCare Ohio to all counties.
  • Requires a successor program to be established and for ODM to establish care management and coordination requirements. 

• Medicaid waiver for reentry services – O.R.C. 50
  • Requires ODM to establish a Medicaid waiver and apply for approval to “provide mental health, behavioral health, and substance use disorder services to Medicaid-eligible inmates who are within 90 days of release, and provide a thirty-day supply of prescription medication at the time of release, including medication administered by injection”.

• Medicaid in schools program – O.R.C. 333.15
  • Earmarks funds “to be used by ODM to support the Medicaid in Schools Program.”

• Home and community-based services direct care worker wages – O.R.C. 333.270
  • “Requires ODM, jointly with ODA and DODD, to collect data from providers regarding wages paid to direct care workers under the Medicaid home and community-based waiver components administered by each agency.”
  • Requires the report to be submitted to the governor, the President and Minority Leader of both the House and the Senate, and the chairperson of both the House and the Senate Medicaid Committees.

• Rural (Southern) Ohio Hospital Tax Pilot Program and Assessments – O.R.C. 333.290, 333.300
  • Changes the name of the program to the Rural Ohio Hospital Tax Pilot Program, with a focus on rural Ohio hospitals.
  • Clarifies that any rural hospital or critical access hospital that is enrolled in Medicaid can participate in the program.
  • Rural counties that are part of the pilot program include:
    Fayette, Greene, Highland, Hocking, Muskingum, Perry, Pike, Ross, Scioto, and Washington.
  • In addition, the legislation addresses funding changes and opportunities for those counties.

• Legislative notice of Medicaid amendments and waivers – O.R.C. 5162.08, 5166.03
  • “Requires ODM to provide notice . . . before seeking an amendment to the Medicaid state plan or a Medicaid waiver that would (1) expand Medicaid coverage to any additional individuals or class of individuals or (2) increase any net costs to the state.
  • Requires ODM to provide updates and solicit input from JMOC and the House and Senate Medicaid Committees in regard to amendments or waivers.
  • To submit an 1115 Medicaid waiver, the ODM Director must confirm with the Speaker of the House and the President of the Senate that the requirements are met.

• Non-emergency medical transportation – O.R.C. 333.160
  • “Permits the OBM director at the request of the ODM director . . . to transfer state share appropriations . . .  to ensure access to a non-emergency medical transportation brokerage program.”

• School-Based Health Care (SBHC): Includes $20 million of funding for SBHC over the biennium.

Prior to signing HB 96 into law, Governor DeWine vetoed a number of policy proposals included in the budget. The vetoes that will have an impact on the healthcare industry include:

• Pharmacy Benefit Managers – O.R.C. 01, 3959.111, 3959.121
  • The Governor removed the Pharmacy Benefit Managers Reimbursements to pharmacy out of the budget due to drafting errors as requested by the House and Senate.

• Continuous Medicaid Enrollment for Children – O.R.C. 5166.45
  • Continuous Medicaid Enrollment for Children, as provided in O.R.C. 5166.45, under the age of four is continuing and will not be removed.

• Electronic Visit Verification – O.R.C. 5164.451
  • Electronic Visit Verification remains a requirement to comply with federal law.

• Automatic Enrollment in Medicaid Managed Care Organization Plan – O.R.C. 5167.03
  • Removes the proposed requirement for individuals to choose an MCO and if they do not, they will be automatically enrolled.

• Nursing Facility Dialysis Services Rate Add-On – O.R.C. 263
  • Eliminates the proposed add-on rate “of $150 dollars per treatment for dialysis services provided in a nursing facility.”

• Medicaid Personal Needs Allowance – O.R.C. 5163.33
  • The budget proposed to increase the Medicaid personal needs allowance from $50 to $75. The Governor vetoed this language but directed ODM to “implement the increase through the rule-making process” to make sure it is not retroactive.

• Transfer agreements with freestanding birthing centers – O.R.C. 3722.15
  • Vetoed budget language that required hospitals with a maternity unit that accept Medicaid to enter into a transfer agreement with any freestanding birthing center located within a 30-mile radius that requests one.

• 340B Reporting Requirements Non-Profit Hospitals – O.R.C. 3701.88
  • Maintains Covered Entity reporting requirement but removes reporting restrictions placed on ODH. The reporting requirements include information from payors, “total payments made by covered entities,” “information regarding the covered entity’s contract pharmacies,” and “a detailed, itemized accounting of the covered entity’s expenditures from 340B drug pricing program profits.”

Contact BMD Member Daphne Kackloudis at dlkackloudis@bmdllc.com with questions.