July 13, 2026 Legislative Update
July 13, 2026
Jan Lanier, JD, RN
SB 315, which ultimately became the vehicle for dealing with alleged Medicaid fraud attributed to home health care agencies, was signed by the governor on July 7th . It will become effective October 5th (90 days after the governor’s signature). The bill does the following to address fraud allegations:
- The Ohio Department of Medicaid (ODM) is required to suspend payments if the state’s attorney general or auditor submits a credible allegation of fraud.
- The criminal penalties for fraud are
- Electronic verification of home care visits is required if the care provider doesn’t live in the
- Whistleblower protections are
A panel of 13 economists was surveyed about how beneficial the bill would actually be in eliminating fraud and whether the benefits outweigh the administrative costs. They were also asked whether the new requirements for verifications and inspections and increased penalties would reduce access for vulnerable populations. Generally, the panel was divided somewhat evenly on the questions with no resounding conviction that the predicted fraud prevention would be achieved. (Source: Schladen, M. (7/6/26) Ohio economists split on Medicaid fraud-prevention proposal. Ohio Capital Journal.)
HB 347, the bill requiring a 24-hour wait time before a woman can undergo an abortion procedure, is now before the Senate Health Committee after having cleared the house along party lines. Prior to the current recess, the committee heard testimony from physicians in opposition to the legislation. Family medicine resident physician, Dr. Annalise Celano reminded legislators that informed consent is a critical and heavily mandated aspect of all medical care. The waiting period creates more barriers to care. “The bill would be legally forcing me to coerce my patients into doing what state legislators want me to do, not what is best for them and their families, ” Celano concluded. The seven-person committee is made up of three physicians, Sen. Beth Liston (D-Dublin), committee chair Sen. Steve Hu<man (R- Tipp City) and Sen. Terry Johnson (R-Scioto County). Organized medical groups such as the Ohio Academy of Family Physicians, and the American College of Obstetricians and Gynecologists-Ohio chapter testified in opposition, but the Ohio State Medical Association (OSMA) has not weighed in thus far. This is one of those bills whose fate may be decided based on election results.
Speculation & Observations
Congress is mired down in political positioning and in-fighting, so accurately predicting what will happen next is no easy task. In addition, the Ohio General Assembly is on recess until after the November Election unless leaders decide reconvening is needed due to some emergency. As a result, most of the news out of D.C. and Columbus is largely speculation. However, that speculation can be informative and worth noting.
According to the Washington Post Health Brief (7-8-26):
- Health insurers are signaling that 2027 could bring another difficult year, with rising medical costs colliding with less healthy patients resulting in increasing The latest rate filings suggest insurers are pricing for a market they believe has become riskier. If those assumptions are correct the exchanges could see additional premium hikes, fewer participating insurers and continued enrollment declines. The underlying medical costs that drive up premiums are likely to rise 9% in 2027 for group health insurance and 8.5% for the ACA marketplaces. These increases are on top of those already seen for 2025 and 2026. Insurers cite higher hospital costs, GLP-1 weight loss medications as major cost pressures. Trump policies (expiration of ACA premium tax credits & new marketplace rules) have changed who remains enrolled, leaving a less healthy risk pool that costs more to insure. National health care costs comprise more than $5.5 trillion annually. Enrollment in individual ACA marketplace plans has fallen by 3 million people and six insurers have said they will leave the marketplaces, both of which further complicate matters and results in even sicker individuals remaining covered and more costs.
- Vaccines are still on the HHS plans to propose a new table identifying specific injuries presumed to be caused by Covid-19 vaccines and treatments along with the time frames in which the injuries must occur to qualify for compensation. The move makes it easier for individuals who claim to be injured by these products to receive compensation. It is uncertain, however which conditions will be added. Rulemaking is scheduled to begin in November.
- CMS intends to propose a mandatory pilot program to test “ways to further its goals of reducing Medicare expenditures while preserving or enhancing the quality of care for the patients.” The initial notice may be released in late July.
- Surprise medical bill rulemaking continues. Additional regulations implementing the “No Surprises Act’s” independent dispute resolution process remain on the agenda which signals that more work remains on this significant policy issue.
- The annual CMS Medicare physician payment rule proposal will ultimately determine next year’s payment policies for physicians and other clinicians. The Trump administration capped payments for skin substitutes.
