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Legislative Update: April 7, 2025

Jan Lanier, JD, RN

Budget Bill Update  Sub HB 96

The House Finance Committee is putting its finishing touches on its version of HB 96 expecting to have it ready for floor action the week of April 7^th.   Changes to the original bill (based on the governor’s executive budget)  were made in  a substitute bill that was released April 1^st .  An additional omnibus amendment is expected to be adopted by the committee before the bill goes to the house floor.

In general,  house finance committee chair Brian Stewart (R-Ashville) reported that there is widespread aversion to tax increases and widespread desire to approve additional funds for public schools.  Increasing the cigarette tax to pay for a $1,000 child tax credit has been questioned by both the Seaker of the House (Matt Huffman) and senate president (Rob McColley).  “Republicans are reportedly wary of establishing long-term spending from a declining source of revenue.  Huffman believes there are more effective programs than the proposed tax credit championed by Governor DeWine.

Much of the focus in the budget has been on two issues, school funding and Medicaid.  The Medicaid discussions have centered on proposed work requirements to be eligible to receive Medicaid and whether to maintain Medicaid expansion that Ohio adopted many years ago.

The Ohio Department of Medicaid (ODM)  submitted Ohio’s application to the Center for Medicare & Medicaid Services (CMMS) to begin requiring the so-called Group VIII* expansion population to work unless they are over 55, enrolled in school or an occupational training program, participating in an alcohol addiction treatment program, or have intensive physical health care needs or serious mental illness. (Source: Gongwer-Ohio (3/20/25) Medicaid work requirements forge ahead. Gongwer News Service Columbus, OH)  (*Group VIII refers to the adult population, specifically those aged 19 to 64 with incomes below 138% of the Federal Poverty Level (FPL) who became eligible for Medicaid in conjunction with passage of the Affordable Care Act. States were offered the option to expand their Medicaid eligibility criteria to include these individuals with the federal government  paying 100% of the cost in 2014 as an incentive for states to participate.  The federal contribution or share  gradually decreased to a maximum of 90% of the cost moving forward.  Whether the federal government will continue to pay its 90%  share is unclear). 

• Ohio’s submission to CMMS came after an extensive public comment period that yielded 654 responses, 589 of which were in opposition.
• It is estimated that 62,000 Ohioans would lose eligibility over the next two years if the waiver is approved. The group VIII population includes nearly 800,000 individuals.  (40.7% of that number are already working, 2.4% are in substance use disorder inpatient residential treatment and 7.9% have a severe chronic condition).
• A previous work requirement cost Ohio $20 million in 2019, but it was never implemented.
• Opponents point out that for a projected savings of $7 million, 62,000 people will no longer have health insurance. The cost of uncompensated care is a huge concern especially for safety net hospitals.  Some state work requirement programs that have been implemented elsewhere are being rescinded because they were not cost effective.
• Looming large is uncertainty regarding what the federal government is likely to do. It may eliminate Group VIII eligibility all together or reduce the federal share that states receive for including these individuals as part of their Medicaid enrollees.  (90% as opposed to 64.6% it pays for other enrollees)
• The expansion brings in millions of dollars to Ohio that go directly to health care providers across the state thereby boosting Ohio’s economy.
• The Department of Rehab & Corrections would need to begin paying 100% of its prisoners’ care in some cases, the state would lose $72 million in drug rebates & $415 million in managed care taxes.
• Currently the budget has language that will automatically remove Ohio from the expansion program if the federal match falls below 90%. Medicaid Director Maureen Corcoran asked that the legislators consider a gradual  or phased in exit from the program.
• The Governor’s proposed “sin tax” increases on cigarettes, marijuana, & sports gambling are eliminated from the house sub bill, and it is not clear how those dollars will be replaced.  Ohio must enact a balanced budget by June 30^th
• The proposed increase in the state’s cigarette tax from $1.60 to $3.10 and a similar increase on vaping products used to cover the nearly $1 billion price tag of a state income tax credit of $1000 per child for parents of kids aged 6 and younger with certain income eligibility limits.
• Taxes on marijuana also remain undecided both as to the amount and whether the money generated will be earmarked either for certain programs or go to the state’s general revenue fund.

 

On to education

Briefly, the education debate centers around funding for public schools.  Whether the school funding formula enacted several years ago will continue to be honored or will that money be cut? Educators and school leaders have been urging that Gov. DeWine’s proposal be reworked to ensure more dollars flow to traditional public schools.  The cost for that would be generated by updating cost inputs to the school funding formula, which currently does not adequately reflect inflation.   The $1.8 billion price tag is a stumbling block, however. So far, no compromise has been reached on this issue.   The private school voucher program has received approximately $1billion with another $500 million likely to be added in this year’s budget, putting significant strain on available dollars that could be used elsewhere.  The sustainability of the funding stream to public education using general revenue funds (GRF) as proposed by the formula  has been questioned by  house leadership.

House minority leader Rep. Allison Russo (D-Upper Arlington)  said the tactic of  using the state budget to short circuit the gender identity debate in the legislature is an attempt by house republican leaders  to distract  its members from the damage the budget is doing to real people.  Provisions establishing state policy that recognizes only two sexes, male and female are the focus of Leader Russo’s concerns.  Speaker Matt Huffman (R-Lima) sees including the language in the budget as ending the discussion in the state of Ohio which he believes most citizens want and prevents the legislature from “having months and weeks of arguments if you do it  (as part of another) bill.)” The language is also consistent with a federal executive order issued by President Donald Trump in February.  (Gongwer -Ohio (4/3/25) Gender identity budget changes spark contention. Gongwer News Service.  Columbus, OH).  Democrats described the latest version of the bill as an attack on public schools and libraries that fails to meet the needs of everyday Ohioans without improving lives and communities. (Source: Gongwer-Ohio (4/1/25) House eliminates sin tax increases from budget measure. Gongwer News Service. Columbus, OH)

Following is a list of specific changes that may be of interest to nurses and/or have an impact on health care. This list is not all-inclusive, and changes are likely, but it does provide a starting point to  get a sense of how house leadership is approaching this budget.   Look for trends, particularly with respect to funding for public health initiatives.  Ohio has long underfunded this vital health care partner which makes it difficult for the state to holistically  and affordably address its citizens’  overall health care needs and general well-being.  That public policy approach continues in this budget cycle.

 

Education-specific

• Modifies the state foundation funding formula to ensure no district receives less in state aid than its fiscal year (FY) 25 amount; provides additional aid to districts based off a calculation of their proposed FY26 and FY27 aid amounts, plus a per-pupil supplement for all schools and an additional per-pupil supplement for districts with growing enrollment. (This is a highly controversial change and is likely to be the subject of several amendment attempts. Supporters describe the language as an increase in funding to public education while opponents note it does not keep pace with inflation and is not consistent with the agreed upon funding formula currently used to determine the state’s financial support to public schools).

Additional school funding formula amounts:

FY26: +$81,000,000

FY27: +$145,000,000

• Removes a provision that requires each public school participating in the federal school breakfast or lunch program to provide free lunch or breakfast to all Community Eligibility Provision (CEP)-eligible students.
• Reduces funding for school bus driver training in FY 27.
• Eliminates the school bus safety program & funding.

 

Higher Education-specific

• Prohibits each state university from charging a guaranteed amount of tuition & fees more than 3% above what was charged to the prior academic year’s cohort for the 2025-2026 or the 2026-2027 academic years.
• Requires the formula used to distribute $100 million in each FY from State Share of Instruction to be based on retention-rate outcomes of graduates and employment data.  Applies this standard to the formula used to distribute $10,000,000 each in FY in State Institution of Instruction for technician-aligned associate degrees.
• Establishes the Higher Education Public Policy Research Consortium to develop materials & maintain a statewide research agenda. Establishes competitive research grants of up to $10,000 and appropriates $1 million each FY to award the grants.
• Requires each state university to establish an accredited accelerated 90-hour program that is aligned to an in-demand career area. Modifies the calculation for SSI to include 5% to support College Credit Plus pathways and 5% for student success.

 

General Government-specific

• Requires controlling board approval for the Office of Budget and Management (OBM) director to transfer up to $3 million cash in each FY from the Research & Development Loan Fund to the Business Assistance Fund.
• Prohibits the Treasurer of State, the state board of deposit, the treasurer or the governing board of a municipal corporation, the investment authority of a county, or any person or entity to which the management and investment of public money is delegated from making an investment decision with the primary purpose of influencing environmental, social, personal, or ideological policy unless it is expressly authorized by Ohio law.
• Requires state employees to return to on-site work beginning January 1, 2026.
• Removes authority for the Common Sense Initiative (CSI) to review occupational licenses and to require an occupational licensing board to report specified information regarding the occupational license’s application process time to CSI.
• Appropriates $485 million in FY 26 and $495 million in FY 27 for the Public Library Fund (PLF), distributes these funds to counties based on a per capita distribution formula, and eliminates the requirement that a percentage of the general revenue fund (GRF) be dedicated to the PLF. (Libraries are strongly opposing what will be a cut in their funding).

 

Health & Human Services-specific

• Requires a health plan insurer to offer at least one method of payment that does not require the health provider to pay an associated fee.
• Requires ODM to resume prior authorization requirements for drugs, tests and diagnostic procedures, and medical procedures under the Medicaid program that were in effect June 29, 2024.
• Increases funding for the Behavioral Health Drug Reimbursement Program by $2 million each FY.
• Limits Medicaid coverage of doula services to the six counties with the highest infant mortality rates and requires total payment for doula services not to exceed $500,000 in a given FY.( There has been some confusion about how the infant mortality rate is to be calculated. Will county eligibility be based on the number of live births or the total  number of births overall.
• Provides $500,000 in FY 26 for Birthing Beautiful Communities.
• ODM must submit a waiver that will eliminate mandatory hospital presumptive eligibility and restrict it to pregnant women and children.
• Prohibits the Ohio Department of Job & Family Services (ODJFS) from requesting or renewing a federal waiver for SNAP (Supplemental Nutrition Assistance Program, formerly known as “food stamps”) work requirements for able-bodied adults without dependents.
• Creates the Ibogaine Treatment Study Committee to study and evaluate the use of ibogaine for various mental health and substance use disorders.
• Decreases the Tobacco Use Prevention, Cessation, & Enforcement fund by $4 million each FY & eliminates $20 million cash transfer to the fund from the Pre-Securitization Tobacco Payments Fund.
• Eliminates the law that requires ODM to seek approval to provide continuous Medicaid enrollment for Medicaid-eligible children from birth to age three
• Provides $190,000 each FY to provide family support services and respite care for children with disabilities and their families.
• Removes authorization of a refundable income tax credit for dependent children (as proposed by Gov. DeWine’s executive budget)
• Instructs ODM to conduct a comprehensive study on the feasibility, legality, and potential cost savings of establishing a Medicaid waiver component that establishes work requirements and includes supplemental workforce development requirements.
• Establishes the Childcare Recruitment & Mentorship Grant Program to increase the number of childcare providers and earmarks $3.2 million in FY 26.
• Removes all provisions in DeWine’s executive budget related to the 340B program
• Within 2 years, ODM shall establish a waiver component to provide reentry services to Medicaid-eligible imprisoned individuals for 90 days before an imprisoned individual’s expected release date.
• Creates a personal income deduction of up to $750 per year for contributions made to certain pregnancy resource centers.
• Provides $150,000 each FY to Challenge Ministries.
• Decreases Imagination Library funding by $2 million each fiscal year.
• Decreases Help Me Grow by $22,521,869 in FY 2027.
• Removes the establishment of the Pretrial Behavioral Health Intervention Pilot Program.
• Reduces Infant Vitality to $20 million each FY and reduces earmarks supporting community and local faith-based service provider programming to not less than $6 million each FY.
• Reduces Strong Families Strong Communities by $5 million in FY 26 and reduces earmark for pediatric cancer research by the same amount.
• Makes Temporary Assistance for Needy Families (TANF) earmarks to several entities & programs, including the governor’s office of faith-based and community initiatives, the Scout Reach program, Bethany House Services, Big Brother Big Sisters of Northwest Ohio, Child Focus Inc., Dads 2B, the Foundry Row, Sail, Dream program, Ohio Guidestone, Open Doors Academy, Produce Perks, Ohio YMCA day camps, & before & afterschool programming.
• Appropriates $20 million each FY for the 988 Suicide Crisis Hotline and eliminates predecessor fund, 988 Suicide Crisis & Response.
• Requires Joint Medicaid Oversight Committee (JMOC) to approve any new state directed payment program.
• Modifies the Group VIII trigger such that ODM will establish a phased transition plan to assist individuals who are no longer Medicaid-eligible by redirecting them to private insurance subsidies or charity care programs that provide medical assistance, and that ODM can establish a temporary hospital assessment to offset the cost of uncompensated care that may result from providing medical care to former members of Group VIII.
• To the extent permitted by federal law, prohibit ODM from paying for DEI.
• Modifies the executive budget’s proposed trigger to state that if the trigger is activated (the federal government no longer will cover a minimum of 90% of the Medicaid costs for Group VIII individuals) Group VIII services will cease immediately, and ODM must report the total actual expenditure for Group VIII for the most recently completed month to OBM, JMOC, and the legislature.
• Moves the Medicaid in Schools program from the Department of Education  and Workforce (DEW)  to ODM.
• Prohibits Medicaid providers from receiving payment rates exceeding the median rate paid by private insurers & imposes penalties on those who violate this prohibition.
• During FY 27, requires ODM to establish an outreach program to help Medicaid recipients obtain private insurance.
• Limits the private room incentive rate for nursing homes to 5,000 rooms.
• Decreases the transfer to a maximum of $2.2 million each FY from Medicaid Services-Recoveries to Behavioral Health Care.
• Reduces the maximum transfer to $9.3 million each FY from Medicaid Services-Long Term to Ombudsman Support.
• Removes provisions requiring ODM director to deposit $2.5 million each FY into Medicaid Services-Recovery from the first installment of assessments and intergovernmental transfers made under the Hospital Care Assistance Program (HCAP).
• Removes authority for OBM director to increase Medicaid Services-Recoveries and appropriate additional funds.
• Removes the prohibition on leasing certain REIT facilities by nursing homes or hospitals.
• Decreases appropriation for the OhioSee Program.
• Provides $800.000 each FY for brain injury research, earmarks $300,000 each FY for the Brain Injury Association of Ohio.
• Clarifies that school-based health centers must obtain consent from a parent before providing medical care to children, except in emergency situations.
• Prohibits any earmarked funds for youth homelessness to be used for gender affirming care.
• Removes the exception allowing ODH Genetic Services funds to be used to counsel or refer for abortion in the case of a medical emergency.
• Defines that there are only two sexes.
• Eliminates ODH’s Lead Safe Home Program and Lead Abatement Program.
• Removes a provision that establishes supported decision-making for certain adults with developmental disabilities.
• Provides $7.8 million in each FY for Ohio Adolescent Health Centers. Requires DODD to consult with certain entities prior to authorizing a pilot project.
• Creates a voluntary donation check-off for the Save Our Sight Fund during professional licensure or renewal process.
• Decreases funding for Chronic Diseases, Injury Prevention, & Drug Overdoses and reduces earmarks.
• Prohibits ODH from adopting rules requiring a soil evaluator or soil scientist to evaluate the soil type and slope for household sewage treatment systems.
• Provides $62,500 each FY to Domestic Violence Project, Inc.
• Removes the authority to rollover unexpended funds from ODH’s infectious Disease Prevention & Control line item.

(Source: Gongwer News Service House GOP HB 96 Synopsis).

 

Childcare-specific

• The governor’s budget contained several provisions that address the childcare crisis affecting families, employers, and ultimately the state’s economic viability.  DeWine proposed to increase the maximum income for a family to be eligible for publicly funded childcare (PFCC) to 160% of the federal poverty level (FPL) rather than the current 145%.  Continued eligibility was increased to 300% from 150% (FPL).  The house version deletes the proposed increases.
• DeWine allocated $427,850,000 for both fiscal years through a TANF block grant. The house cut that amount by $150,000,000 for each FY.
• DeWine proposed expansion of the Childcare Choice Voucher to include families whose income does not exceed 200% FPL. The cost was estimated to be $75 million in FY 26 and $150 million in FY 27 adding 29,000 children to the program.  The house version capped the voucher program at $50 million in each fiscal year.
• The governor also proposed a $1000 refundable tax credit per child through age six for working parents who hold a fulltime minimum wage job. That credit was eliminated in the house sub bill.
• The house proposal establishes a childcare recruitment & mentorship grant program to help increase the number of licensed childcare providers and earmarks $3.2 million for this endeavor.

(Source: Groundwork Ohio)

 

Other issues of note

While most of the attention is focused on the budget, other issues also cannot be ignored.  One of particular note relates to an Executive Order  issued by President Donald Trump that requires proof of U.S. citizenship to register to vote and prohibiting absentee ballots received after election day from being counted. Even though the incidence of non-citizen voting is rare, the order requires people who register to vote with the national mail voter registration form to provide a U.S. passport, military ID or REAL ID-compliant driver’s license or state registration card.  Applicants can also submit a valid federal or state government-issued photo identification provided it provides proof of citizenship.  Failure to enforce the order would lead to a loss of federal election funding.

It is already illegal for non-citizens to vote in Ohio.  Despite only six people being indicted for illegal voting last year, several steps have been taken by the general assembly to add additional safeguards.  The Bureau of Motor Vehicles must put a “noncitizen” label on the driver’s licenses and state IDs of Ohioans who are not citizens.  People with those designations must provide proof of citizenship to vote.  Ohio uses its own registration form that is similar to the federal form.

(Source:  BeMiller, H. (3/26/25) Proof of citizenship, absentee ballots: What Trump order means for Ohio elections. Columbus Dispatch).

The order will impact Ohioans who vote absentee.  Currently, election officials can count mail-in ballots received up to four days after the election provided, they were postmarked the Monday before the election day.  These grace periods are prohibited by the executive order.

Senator Theresa Gavaronne (R-Bowling Green) introduced SB 153 that requires Ohio voters to prove citizenship if they cast a ballot.  The bill was introduced March 19^th and referred to the senate general government committee. It is scheduled for its first hearing on April 8^th.  The bill broadly addresses several aspects of the election process including voter registration requirements, maintenance of voter rolls, absentee voting and election petitions.  The bill identifies what constitutes “proof of citizenship”, but exactly who will be required to provide such proof is not totally clear.