Legislative Update
Janice Lanier JD RN
Liaison Public Policy Committee
Ohio has a Budget Bill—HB 96
Budget hearings are well underway, and the actual bill is available for public scrutiny. The executive director of the Ohio Board of Nursing (Board), Marlene Anielski testified before the House Health Committee on February 13th to provide background information about the Board’s activities. She also explained the Board’s request for a 3.3% increase in FY26 to $14.4 million and another 3.2% increase in FY27 to $14.8 million. The request is largely due to the addition of doulas to the board’s regulatory responsibilities and the expenses associated with administering the nurse licensure compact. The increased appropriation does not include a fee increase because the Board’s licensure income still exceeds its expenses. No general revenue funds are part of the appropriation. It is entirely funded by its licensees and certificate holders. The Board remains the largest regulatory entity in the state.
Health committee members asked about the effects of the licensure compact on the Board’s funding and operations. There are now approximately 43,000 nurses who hold an Ohio multistate license while 6,600 non-Ohio residents practice in the state while holding a license issued by another compact state. Generally, Ms. Anielski discussed outreach efforts to improve efficiencies, communications, and encourage employers to utilize the newly developed tools that allow them to track the licensure status of their employees, including those nurses residing outside Ohio who are practicing in the state by virtue of a multistate license. The Board has also been able to decrease the wait time for processing licensure applications to one-three days.
In response to a question about disciplinary actions, Anielski noted the number of complaints received went up 22% in 2024 over the number in 2022. She called committee members’ attention to a non-budgetary request in the bill and explained the board currently does not have the authority to require licensees and certificate holders to cooperate with them in addressing compliance matters like many other boards do. The proposed budget gives the Board that additional authority. She asked that the legislature retain that provision.
Other policy considerations in the budget that HB 96 might address
Elimination of Medicaid expansion program
As in any budget year lawmakers take a close look at high-cost programs that have a major impact on the state’s bottom line. Public education and Medicaid are two of those programs under the microscope in 2025.
The possibility of repealing Ohio’s Medicaid expansion approved in 2014 under Gov. John Kasich could affect over 700,000 Ohioans who have benefitted from the program almost since its inception. When the expansion was originally proposed, the federal government agreed to pay 100% of the cost for a period, with that percentage gradually decreasing until it reached 90%. Ohio lawmakers are now considering repealing the expansion outright or including a provision in the budget that would repeal the expansion if the federal government lowers its contribution to less that 90%--a likely prospect given the climate in Washington. Rural health systems would be hit the hardest by eliminating the expansion because those areas have a higher percentage of residents enrolled in Medicaid according to the Ohio Department of Medicaid. Without coverage individuals would have a difficult time accessing the health system.
For senate leadership the decision will be based on dollars and cents. The budget must be balanced noted Senate President Rob McColley R-Napoleon; however, others believe there are ways to achieve that goal by making cuts elsewhere.
Medicaid work requirement
In addition to the possible repeal of the expansion, the state is also seriously considering imposing a work requirement for the Medicaid program despite that requirement being criticized as ineffective by some of the states that have tried it.
Under the Ohio Department of Medicaid work requirement, adults under age 55 would be required to prove they work at least 20 hours/week to qualify for Medicaid or have an exception, school enrollment, or intensive physical care needs. Under Donald Trump’s first administration, 12 states imposed work requirements, but Arkansas and Georgia are in the process of scaling back the requirement due to administrative burdens and unforeseen consequences.
Some of those consequences were reported in an Arkansas study that found work requirements did not increase employment. However, people between the ages of 30-49 who had lost Medicaid in the prior year experienced adverse consequences. Fifty percent had problems paying medical debt, 56% delayed care due to cost, and 64% delayed taking medications due to cost.
In Ohio, proponents say a work requirement would empower people to reach their full potential. Opponents predict 61,000 Ohioans would lose access to Medicaid under the work rule while others predict the number of people who would lose access to care would exceed 450,000.
A registered nurse, Alex Fay, from Cleveland wrote the following to the Department of Medicaid, “I work with patients who are on Medicaid, many of whom are not able to work due to physical and mental health concerns. Who will decide what qualifies as working? Or searching for work? Or who’s too ill to work? What about patients with circumstances such as being homeless or in a domestic violence situation? Will they be expected to work?” (Source: Pope, Z (2/20/25) Ohio medical professionals’ express outrage, opposition to Medicaid work requirement proposal. Ohio Capital Journal.)
Many of these significant policy issues will be addressed in some way in HB 96. The house hopes to pass the budget bill by the second week in April with the senate poised to begin its deliberations the week of March 31-April 7th. After the legislature’s spring break, six standing committees in the senate (education, higher education, Medicaid, health, agriculture and natural resources, and government oversight and reform) will hold budget hearings. Senate finance committee chair Sen. Jerry Cirino (R-Kirtland) will then meet with the finance committee vice chair and the senate finance director and individual senators to learn their budget initiatives and priorities . The final omnibus bill is expected in mid-June. The bill must be signed by June 30th to become effective July 1st.
(Sources: Gongwer (2/18/25) Senate finance chair lays out budget timeline Gongwer News Service.
Glynn, E. & Hendrickson, S. (2/2/2025) Ohio lawmakers consider repealing Medicaid expansion for 770,000 residents. The Columbus Dispatch. Columbus, OH)
Other bills
SB 56 sponsored by Sen. Steve Huffman (R-Tipp City) is before the Senate General Government Committee where committee members accepted a substitute bill on 2/18/25. The changes, in part, ensure that any marijuana rules already adopted remain in effect. It also clarifies that existing license holders do not need to apply for a new license, advertising must be reviewed, dispensaries are banned from being located within 500 feet of a prohibited facility, and tax rate and revenue distribution provisions are removed saying the current budget bill (HB 96) will address those issues separately.
Opponents believe the bill is an attempt to override the will of the people who passed an initiated statute in November 2023. Although the voters demonstrated support for the language included on the ballot, legislators can make changes to that language to “tidy up” what voters approved. HB 56 goes way beyond that limitation argued opponents.
(Source: Gongwer-Ohio (2/19/25) State marijuana plan could see further changes. Gongwer News Service)
On the federal scene
U.S. Representatives Dave Joyce of Ohio, Suzanne Bonamici, Oregon; Jen Kiggans Virginia and Lauren Underwood Illinois along with U.S. senators Jeff Merkley Oregon, and Cynthia Lummis, Wyoming reintroduced the Improving Care and Access to Nurses (I CAN) Act. According to a February press release from Congressman Joyce, the bipartisan bill would increase healthcare access, improve quality of care, and lower costs by removing the remaining barriers imposed by the federal government in the Medicare and Medicaid programs that prevent advanced practice registered nurses (APRNs) from practicing the full scope of their education and clinical training to the level approved in the state where they practice. Eliminating the unnecessary federal barrier would increase access to care and strengthen patient choice. (Source: Congressman Dave Joyce (2/14/25) Joyce, colleagues reintroduce bipartisan bicameral bill to increase access to nurses. United States House of Representatives Washington, D.C.)
Nurse Licensure Compact Update.
The Nurse Licensure Compact (NLC) is now 25 -years old. Forty-three states participate in the NLC (including Ohio) with five more (Hawaii, Illinois, New York, Nevada, and Oregon the district of Columbia) currently having bills pending to also join. In addition, the APRN compact continues to attract participants but still needs three more states to come on board. A total of seven states must enact the compact to make it effective. The APRN compact legislation has been introduced in four states (Arizona, Arkansas, Kansas, and Montana) so nurses’ efforts continue to make legislators aware of the benefits a compact can have on access to care. (Source: Compact connection (2/24/25) Legislative update. National council of State Boards of Nursing, Chicago, IL)
