.jpg)
.png)
Just ahead of the legislative spring break, the Ohio House of Representatives passed its version of the state budget, now officially Amended Substitute House Bill 96. The bill will continue its journey through the legislative process in the Senate the week of April 28, where several standing Senate committees will serve as budget-focused committees for the next few weeks. State agencies, boards, and commissions will present testimony across these committees (see table).
Public testimony related to these agencies and boards/commissions and the issues they cover will also be heard in these respective committees in the coming weeks. Public testimony is likely to begin the week of May 5 in some committees.
This overview will benchmark the status of funding and policy across much of health and human services, but is not comprehensive of the entire budget. Visit the Ohio Legislative Service Commission for information on all sections of the state budget.
Medicaid
Trigger language and associated Group VIII transition plan language
There were numerous and significant changes across the Medicaid program made by the Ohio House. The House made changes to the so-called trigger language that the Governor included in his introduced budget. Sub. HB 96 now requires that if, during fiscal year 2026 or fiscal year 2027, the Federal Medical Assistance Percentage (FMAP) for the Medicaid expansion eligibility group (Group VIII) falls below 90 percent, the Ohio Department of Medicaid (ODM) must establish a phased transition plan. That plan must assist individuals who lose eligibility by facilitating their enrollment in private insurance premium subsidy programs or charity care initiatives. Though a transition plan is mentioned, there are little other details offered. There is no mention of how the transition plan will occur or how the plan will be facilitated.
Additional Joint Medicaid Oversight Committee (JMOC) oversight
The substitute bill adds multiple layers of data sharing with the Joint Medicaid Oversight Committee (JMOC), which will create more process for state agencies. By October 1, 2025, the Ohio Department of Medicaid (ODM), the Ohio Department of Job and Family Services (ODJFS), and each county job and family services agency must grant JMOC staff access to all eligibility, billing, payment, and provider tracking systems, together with necessary training and confidentiality protections. Beginning on that same date and every six months thereafter, ODM must deliver specified data files to JMOC’s contracted actuary, and each managed care organization must undergo an annual financial audit with results provided to both JMOC and the General Assembly. Additionally, ODM is obligated to submit an annual report by September 1 of each year detailing agency full‑time equivalent (FTE) positions and related expenditures, and the Auditor of State must complete a performance and fiscal audit of ODM’s Next Generation system by December 31, 2027, with findings sent to JMOC.
Hospital presumptive eligibility changes
ODM is required—by January 1, 2026—to seek a waiver from the Centers for Medicare & Medicaid Services (CMS) that would end mandatory hospital presumptive eligibility except for children and pregnant women. This means that, excluding pregnant women and children, when individuals who likely qualify for Medicaid but have not yet been approved, arrive at a hospital in need of a service, the hospital would no longer be able to presume their Medicaid eligibility on the date of service. Medicaid would need to officially approve an application prior to the hospital billing for a service for an individual who is likely-eligible based on information the Medicaid-eligible person may have been able to provide to the hospital while they were initially receiving a service. The waiver request must incorporate specific hospital performance standards and penalties for noncompliance and must be resubmitted within 24 months if it is initially denied or withdrawn. The amendment also prohibits ODM from self‑designating as a qualified health entity for presumptive eligibility determinations, and it directs the Auditor of State to audit hospital compliance within 90 days of CMS approval.
Medicaid change in circumstances eligibility verification
Sub. HB 96 directs ODM (or its designee), within 30 days of the bill’s effective date, to employ third‑party data sources on a quarterly basis to verify ongoing eligibility for all Medicaid recipients. Individuals found ineligible through this process must be disenrolled, and ODM must report twice yearly to JMOC on verification activities and any instances of suspected fraud, waste, or abuse. The provision further authorizes similar quarterly checks for the expansion population to monitor compliance with work and community engagement requirements and empowers providers to take part in eligibility verification; any vendor costs associated with these data services must be contingent on demonstrable savings to ODM.
A court may order restitution equal to 200 percent of the total amount paid for services when an individual is convicted of Medicaid eligibility fraud.
Elimination of continous coverage for kids
The substitute bill repeals the statute that currently requires continuous Medicaid coverage from birth through the first month of a child’s fourth birthday, thereby restoring standard renewal and redetermination policies for that cohort. This policy was included in the last state operating budget and has not yet been implemented.
Medicaid fraud restitution
Under the current version of HB 96, a court may order restitution equal to 200 percent of the total amount paid for services when an individual is convicted of Medicaid eligibility fraud, strengthening financial deterrents against fraudulent enrollment practices. This could have a negative impact on many Ohioans due to the complexity of determining Medicaid coverage when so many people will undoubtedly experience churn because of the evolving policy landscape.
Medicaid buy-in for workers with disabilities program premiums
As introduced, HB 96 eliminates the annual premium requirement for participants in the Medicaid Buy-In for Workers with Disabilities (MBIWD) program whose income exceeds 150 percent of the federal poverty level. The substitute bill retains that premium elimination and goes further by directing ODM to disregard the first $20,000 of an individual’s unearned income when deciding eligibility for both the Medicaid Buy-In for Workers with Disabilities (MBIWD) and the Ohio WorkAbility programs, thereby reducing financial barriers for working people with disabilities.
Maternal/infant health related changes
The House changes reverse recent progress on infant and maternal health. The House changes related to Medicaid reimbursement for doulas will reduce access to these important services. We talked about how the previous state budget enabled doulas to seek reimbursement from Medicaid, with a goal of improving access to health services for birthing parents throughout the state. However, the House included a provision in the amended substitute bill to limit Medicaid reimbursement for doulas to the six counties with the highest infant deaths. An obvious concern with this provision is that access would be severely limited across the state when Ohio has not made enough progress on reducing infant and maternal deaths.
The House version reduced the earmark for community and local faith-based service providers to six million dollars per fiscal year.
The House reduced funding for some infant and maternal health community programs. There is a decrease in infant vitality funding. Specifically, the House version reduced the earmark for community and local faith-based service providers to six million dollars per fiscal year. Funding for Help Me Grow, a home visiting program, has also been reduced for FY 2027 by about 26 percent (from $85,521,869 to $63,000,000).
There was a new provision concerning transfer agreements between birthing centers and hospitals. The House requires a hospital with a maternity unit that accepts Medicaid to have a transfer agreement with any freestanding birth center that requests one. The freestanding birth center must be within a 30-mile radius of the hospital. The language also requires a freestanding birth center to file a copy of the transfer agreement with the director of the Ohio Department of Health.
Public health
Changes to lead abatement appropriations are notable in the House-passed version of the budget. Two major line items within the Department of Health (DOH) budget are Lead Abatement (440527) and the Lead-Safe Home Fund Project (440530). These two line-items are responsible for funding lead prevention activities, hazard control, and housing rehabilitation. Both line items received substantive reductions in appropriations. The Lead Abatement line-item was zeroed out in the House-passed version of HB 96 for FY 2026 and FY 2027. The initial appropriation for this line item was $1 million for FY 2026 and 2027 in the introduced version of the House budget.
Initial funding levels from the Governor’s budget for the Lead Abatement line-item were $7.04 million and $7.06 million in FY 2026 and FY 2027, respectively. The House passed version appropriates only $250,000 per year to the line-item.
Another area of significance in the budget is the lead abatement tax credit, which raises the maximum amount of the tax credit from $10,000 to $50,000. The tax credit supports property owners who incur costs from lead abatement from eligible dwellings. It is important to note that state law in Ohio limits the total amount of tax credit certificates to $5 million in a fiscal year. This portion of the budget passed in the House version of the budget.
Harm reduction
Sub. HB 96 reduced the dedicated funding, compared to the Governor’s budget proposal, to support local health providers’ harm reduction efforts. The budget includes $315,231 over the biennium for these efforts, reduced from $500,000. The amended substitute bill maintained the Governor’s budget level of funding for state block grants to be allocated to Alcohol, Drug Addiction and Mental Health Services (ADAMHS) boards. While not tied to funding for harm reduction, the substitute bill maintains the Governor’s provision to expand beyond fentanyl testing strips, items that may be lawfully possessed and used to test for the presence of drugs and to prevent drug poisoning, without being in violation of Ohio’s drug paraphernalia laws.
Marijuana tax changes
Both the Governor’s introduced and the House-passed budgets include changes to the distribution of marijuana taxes, especially significant as this changes the distribution of marijuana taxes that were favorably voted on via Issue 2 in the November 2023 election, which legalized adult-use marijuana. The Governor’s budget proposed utilizing marijuana sales tax to fund the 988 Suicide and Crisis Lifeline at $73.0 million over the biennium. The House-passed version of the budget proposes to use funds elsewhere in the budget, at a reduced amount compared to the Governor’s proposal, to support the 988 line.
Additionally, Sub. HB 96 changes the distribution of marijuana sales tax revenue to municipalities. Under current law, these tax revenues are split between municipalities with dispensaries. The bill changes this distribution so that, for the next five years, 20% of state tax revenue from recreational marijuana would be diverted to local municipalities that have at least one dispensary. The money would be divided up proportionally based on how much marijuana tax revenue each local government pays and the remaining 80% would be deposited in the general fund. After five years, all marijuana tax revenue will be deposited into the general fund.
Elimination of the increased tobacco tax results in the removal of the child tax credit
The Governor proposed to institute a refundable tax credit of up to $1,000 for kids aged six or under for low and lower middle-income families. The identified funding for this tax credit was an increase to the state’s tobacco tax. The tax credit and the tax increase were both removed in the House-passed budget. While there is interest amongst the General Assembly in the concept of a child tax credit and more support for working families, the source of revenue turned out to be the sticking point. There was little support amongst most legislators for an increase in the tobacco tax. Ohio is somewhere in the middle as it relates to the cigarette taxes, currently set at $1.60 per pack (compared to the highest in New York at $5.35 per pack and the lowest in Missouri at 17₵ per pack, and a national average of $1.93).
Funding was increased for adult protective services in the House-passed budget from $9.72 million each year to $11.72 million each year, an increase of $2 million per year.
Older Ohioans
As passed by the House, the Ohio Department of Aging (ODA) must issue a request for proposals to any entity who wants to become a Program for All-Inclusive Care for the Elderly (PACE) provider in Ohio. There are currently two PACE sites in Ohio with more opening soon. During the presumptive eligibility period, ODA must seek approval to allow a PACE applicant to use PACE services upon applying. If the applicant becomes ineligible for PACE, then the PACE organization that made the presumptive eligibility determination should cover the costs of those services provided to the person during the presumptive eligibility period.
Funding was increased for adult protective services in the House-passed budget from $9.72 million each year to $11.72 million each year, an increase of $2 million per year. A portion of these funds are evenly distributed across the 88 counties in Ohio, and the remainder is distributed via a formula.
Funding amounts for line items concerning the ombudsmen, Federal Aging Grants, Federal Independence Services, and Alzheimer's and Other Dementia Respite remain the same.
Looking ahead
As the legislature returns from its mid-late April spring break, the budget process will pick up in the Senate. May will see testimony from directors of agencies and boards/commissions in the designated standing Senate committees (see table above) and then head into the public testimony phase. The Senate is preparing to vote on the budget in the first half of June, leaving the remainder of that month for the inevitable budget conference committee where the House and Senate will work out their differences before sending the budget to the Governor’s desk by the statutorily required date of June 30th to have a new fiscal year budget beginning on July 1.
