Getting QIP Payments Right:Recalculating Rates and Back PaymentsIn September 2025, the Supreme Court affirmed that the Ohio Department of Medicaid did not set the correct QIP rates in accordance with the FY 24-25 Ohio operating budget. The Court ordered the agency to recalculate the rates to align with legislation. The Court's ruling also indicated the underpayment of Ohio's nursing home operators since the budget took effect in July 2023. |
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BackgroundThough the Supreme Court's ruling affirmed the plaintiff's (LeadingAge Ohio, OHCA, and The Academy) interpretation of the rates, it only ordered the agency to recalculate the rates. It was silent on the more than $572 million in back payments owed to nursing home operators. The Ohio Department of Medicaid communicated in late January 2026 its intent to recalculate rates and address back payments once legislators make appropriations. LeadingAge Ohio is hopeful that through meaningful dialogue and education with the agency and legislators, recalculations and back payments will be sufficiently addressed.
What's NextLegislative AdvocacyLeadingAge Ohio is actively educating lawmakers on the need for accurate and timely appropriations. We also urge members to connect with their lawmakers about the ongoing delays with appropriate reimbursement and the effects on their organization. Legal ActionWhile the Supreme Court’s ruling on the mandamus action affirmed the rate interpretation and recalculation, it was silent on the disbursement of retroactive payments, leaving that issue to individual providers and lower courts. LeadingAge Ohio is preparing education on legal remedies available to providers should back payments continue to be a prolonged issue. |
ResourcesSpecial Advocacy in Action Grassroots Training: February 16, 2026 Member Toolkit
Find Your LegislatorLegal Remedy Education
Member Communication
MediaOhio Medicaid underpaid nursing homes by $572M: What's happening now with underpayments?
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