January 8, 2026 Legislative Update
Legislative Update
January 8, 2026
Jan Lanier, JD, RN
The general assembly is reconvening after its holiday break with the May 5th primary election looming.
It was relatively quiet around the statehouse while legislators were away for their holiday break. However, that welcome calm will end when lawmakers return in mid-January to again conduct their business. Looming over the next few weeks in Columbus is the May 5th primary election. That critical election will determine who will appear on the November General Election ballot. Voter turnout (typically low for primary elections) is always an important harbinger of what is to come in the months ahead. That is particularly true this year when there is so much uncertainty both in Ohio and in the country as a whole.
General assembly leaders are aware of the need to address issues that will resonate with their supporters and constituents who typically vote in primary elections. It is a time for voters to watch with a discerning eye to see which bills are receiving committee attention and which ones are not AND to go to the polls in May.
It is likely that most of the legislative action will occur between mid-January and late March. The house has no sessions scheduled for April and the senate only one voting session. Those plans can always change of course but being aware of leadership’s overall plan helps people understand the time frame and political motivation that is at work and coloring what does or does not happen at the statehouse.
The capital budget
Generally, in the second year of a legislative session, members may consider what is called the capital budget. This budget differs from the operating budget (enacted in 2025—HB 96) in several ways. The capital budget is usually funded through bond offerings, and it consists of one-time allocations to help fund special public projects such as renovations, repairs, parks, community center construction and the like. The capital budget is not required to be enacted by the state constitution so whether it happens or not in 2026 will depend on how secure legislative leaders are that the projections for the operating budget are holding up without costly surprises down the road.
Reports from the Office of Budget and Management covering the midway point of the current fiscal year show the state has excess revenue totaling $518.2. All major categories out-performed tax receipt estimates, which is good news. However, other considerations may affect the ultimate capital budget decision.
One of those factors is related to property tax increases that legislators have been attempting to address through a series of bills intended to reform many aspects of the property tax process. Whether the reforms enacted late in 2025 are embraced by Ohioans, and whether the group proposing to eliminate property taxes all together is having success in its efforts to have the proposal on the ballot in November will play into the capital budget decisions. The state must also determine how to pay nursing home providers for more than two years of under-payment related to the implementation of the quality incentive formula adopted by the state in 2023. Because of these open questions, the initial leadership conversations will likely be on whether to have a capital budget at all. If there is to be a bill, house and senate leaders will then announce the process to be used for determining how various projects will be submitted by legislators to finance committee leaders in both chambers, and the timing and process for submission. Realistically, being able to tout a budget win on the campaign trail is a key factor for candidates in determining what does or does not survive legislative scrutiny. (Remember all 99 house members will be up for re-election and half of the senate—odd-numbered districts). If there is a capital budget proposal, legislators will be lobbying their colleagues to try to make sure their constituents’ wish lists are granted in some form in the all-important capital bill.
(Sources: Livingston, M. (12/26/25) The year ahead: capital budget, taxation, vetoes and more. Gongwer-Ohio). & Kano, K. (12/26/25) Post-traumatic stress Gongwer-Ohio).
Rural Hospitals
In November, Ohio submitted its application for funds from the Rural Health Transformation Program (RHTP) that was established by the One Big Beautiful Bill (BBB). That bill cut federal funding for Ohio’s Medicaid program by about $33 billion, and according to Kaiser Family Foundation reports, RHTP funds will not replace all the losses expected as a result of other provisions of the BBB. ($56. billion for Ohio over the next ten years).
Half of the funds awarded through the RHTP, go to all states equally ($100 million per state) and the other half is allocated based on proposed initiatives; state policies favored by the Trump administration, such as restrictions on the purchase of unhealthy foods using SNAP benefits; need; application quality; rural population; rural facility numbers; and projected impact. Funding decisions by the Center for Medicare and Medicaid Services (CMS) were announced at the end of 2025.
Ohio received a one-year $202 million award. The Ohio Department of Health (ODH) will oversee management of the grant. When compared with other state awards, Ohio’s amount is middle of the road, ranked 25th overall. Ohio received the fifth-lowest amount of funding per rural resident.
Ohio’s application emphasized access to care issues and worse health outcomes facing the state’s rural populations. Ohio proposed building on existing state investments to increase access to care, strengthen the rural health workforce, and modernization of facilities and technology. The state will build up school-based health centers, telehealth, and value-based reimbursement models, join more interstate licensure compacts, and expand pharmacists’ authority to provide “test to treat” care. Generally, the state’s application promoted programs established by the current general assembly that are not specific to rural populations.
Ohio’s House Rural Hospital Caucus, co-chaired by Reps Kellie Deeter (R-Norwalk) and Meredith Craig (R- Smithville) is advocating that Ohio’s share of RHTP funds to go to independent rural hospitals. Other members of the caucus include republican Reps. Adam Holmes (Nashport), Angie King (Celina), David Thomas (Jefferson), Gary Click (Vickery), Jodi Salvo (Tuscarawas) and democrat representatives Anita Somani (Dublin) and Dani Isaacsohn (Cincinnati). While most hospitals absorb some costs of uncompensated care without having state or federal payments to mitigate the impact, there are 13 independent rural hospitals that are facing more severe financial pressures than others thus making a targeted approach necessary. Caucus co-chair Rep. Craig said the recommendations put forward by the caucus were not included in the state’s RHTP grant application.
According to caucus co-chair Rep Deeter, Ohio’s ultimate allocation was consistent with the proposal submitted by the state. “This announcement largely reflects what was anticipated but still is not enough to offset the federal cuts. The focus should now be on how the funds are deployed to deliver real, sustainable improvements in rural health care”. To that end, ODH offered to “meet with the caucus to provide members a chance to review the award and think strategically about how we can proceed under the terms of the award to ensure rural providers and residents are best served by these resources.”
(Sources: Kano, K. (12/22/25) House republicans urge DeWine to prioritize independent rural hospitals. Gongwer News. Health Policy Institute of Ohio Rural health transition program funding in Ohio retrieved 1/8/26 from https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzQfBGhDKPfMSsvVkhpgbGNrSZsz).
Ohio one of the most medically expensive states
According to a WalletHub analysis of the 100 largest American cities, Ohio had three cities in the top eleven, (Cleveland, Toledo, and Cincinnati) with respect to the cost of care. Between 2000 and 2024 the cost of medical care rose 121% compared with 86% for the overall economy. Cleveland came in 2nd in the recent analysis largely because it has the lowest median household income in the state at $39,187/year (11.35% of the median household income going to meet health care expenses) . The price of medication (insulin and ibuprofen) was relatively high in the city, while the cost of provider visits was relatively low. Toledo came in 4th on the list (spending 11.03% of its median household income on medical care) and Cincinnati was 11th at 8.98%. Columbus was 64th at 6.09%.
According to Consumer Energy Solutions, Ohio electricity consumers have faced increases as high as 44% just in 2025 and grocery prices have jumped more than 29% since 2020. Coupling this news with the fact that Ohioan’s pay has not kept up with inflation, it should come as no surprise that Ohioans are feeling financially pinched. The state’s median annual income dropped from about $71,000 in 2019 to $67,873 in four years per the Ohio Housing Finance Agency. (Source: Schladen, M. (1/5/26) Ohio cities rank among the most medically expensive, analysis finds. Ohio Capital Journal).
Despite the multifaceted money problems facing Ohioans, legislators are focusing the lion’s share of their efforts on property tax relief.
The ANA-Ohio bill tracker available on the ANA-Ohio website has been updated.
Over 900 bills have been introduced so far into this session of the general assembly with many more yet to come. The tracker generally includes bills of most significance to Ohio nurses as well as bills that affect patient care and safety.
