02/15/2024

LeadingAge Ohio Takes Legal Action Against Medicaid

On Tuesday, LeadingAge Ohio took legal action to pursue the Ohio Medicaid rate correction through a petition filed with the Ohio Supreme Court. The Ohio Health Care Association (OHCA) and The Academy of Senior Health Sciences join LeadingAge Ohio in this unified effort to direct the Ohio Department of Medicaid (ODM) to implement quality initiatives as intended in the Ohio 2024-2025 fiscal year budget.

The budget’s revised reimbursement formula mandated that 60% of the fiscal period’s increase in nursing home funding go toward quality incentives. Instead of allocating 60%, ODM officials implemented a faulty calculation that allocates less than 30% of the increase toward quality incentives.

LeadingAge Ohio, OHCA, and The Academy recognized the crucial error in the new reimbursement formula made by the Ohio Department of Medicaid in 2023. The associations responded by submitting a rate reconsideration request to ODM. ODM denied the rate reconsideration request.

Because of the significance of the error, and ODM’s reluctance to rectify the issue, LeadingAge Ohio, along with OHCA and The Academy, deemed legal action necessary.

Questions about the filing should be directed to Susan Wallace at swallace@leadingageohio.org.

Some common questions include: 

What is a Writ of Mandamus?

A Writ of Mandamus is a form of a court order that compels government agencies to fulfill their legal duties when there is a clear legal duty to perform the action and there is no other adequate remedy available.

Why was this filed?

The Administration and the Ohio General Assembly made a concerted effort to prioritize nursing home quality - an effort supported by the three trade associations. These efforts were realized through landmark enhancements to Ohio's quality incentive payments in the Ohio 2024-2025 FY budget.

ODM officials’ faulty calculation of this historic investment undermines the legislation’s intent and the capacity to affect nursing home quality.

The three associations formally asked ODM to reconsider the rate. Because ODM denied the reconsideration request, and because it is imperative ODM be held accountable to the legislative intent set forth in the budget, legal action was a necessary last resort.

What is the anticipated timeline?

The legal proceedings will likely span many months before a resolution is reached.

When will we be informed of updates?

Because this is an ongoing legal issue, we will share information when possible, under advisement from our attorneys.

What should I do if the media reaches out for comment?

All media inquiries pertaining to this matter should be referred to Molly Homan, LeadingAge Ohio director of strategic communications, at mhoman@leadingageohio.org.