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More at OHEA.org Lawmakers head home after pushing through some bills, but leaving a big one behind.

And they move changes to Medicaid, but set aside one that sparked vocal and emotional opposition.

We'll recap all that this weekend.

The state of Ohio.

Welcome to the state of Ohio.

I'm Karen Kasler.

Lawmakers made a mad dash to finish some big bills before summer recess, and ended up approving a couple of them, but pushing off a measure on data centers until later.

There was quick action on a resolution that was introduced less than a month ago.

A constitutional amendment for the fall ballot on the requirement of in-person voters to show photo ID, which is already in state law.

Republicans said that wasn't enough, while Democrats said the amendment, which will appear alongside high profile and potentially competitive race for governor and U.S.

senator this fall, is unnecessary.

Well, the discussion on that idea had some Republicans saying photo ID should be required of Mail-In voters as well, either by sending in a photocopy of a voters ID or showing it when they apply for or return absentee ballots.

Republican leaders tacked that idea onto a bill that had already passed with widespread support that would help homeless people get documents such as birth certificates and state IDs.

The opposition to requiring mail in voters to show ID came from several sources, including two that often disagree.

Republican Secretary of State Frank Larose and Jen Miller from the League of Women Voters of Ohio.

I have a general concern that when something like this is done this quickly, that there can be unintended consequences, even well-intentioned, just drafting errors and that kind of thing.

the way this is written is very sloppy.

It's going to cause a lot of confusion for voters in the technology.

Parts of the legislation.

Aren't well thought out.

Unlike the constitutional amendment resolution, this bill will go to governor Mike DeWine for his signature or veto.

A bill to regulate data centers had been positioned to move before the break.

But when the dust settled late on Wednesday, the bill lay dead.

It would have cut local tax abatements off at 50% and regulated water usage and discharges by facilities.

But the House took issue with how it handled the state's data center sales tax break, which was estimated to cost the state $136 million last year but actually cost $1.6 billion 11 times more.

But some of those tax breaks are untouchable.

Amazon, Meta and Google are benefiting for any facility they build statewide through at least 2055, 2056 and 2058, according to contract documents obtained by the Statehouse News Bureau.

We're Republican Senator Brian Chavez co-chairs the Select Committee on Data Centers, which met the day after the bill died.

the tax exemptions that folks are really upset about are for the hyperscalers that was established in the case of administration, we can't go back.

That cake is baked and half eaten.

There may be some things that we can do, but that's not anything that we can do right now.

Also at that meeting, Department of Development director Lidia michalek said the sales tax break the data centers get is no longer needed.

That puts her in opposition to governor Mike DeWine, who had vetoed state lawmakers attempt to cancel that tax break in the budget.

Speaker Matt Huffman told reporters after session on Wednesday that lawmakers would come back later this month for a data centers bill.

But Chavez said there are no plans for the Senate to return.

Lawmakers also overwhelmingly passed a bill the sponsor said would fight Medicaid fraud in Ohio.

They moved elements of a bill aimed at home health care providers, following a national conservative outlets report alleging hundreds of millions of dollars would paid by Ohio Medicaid to fraudulent providers in 2024.

But they left out a proposal that brought loud opposition a ban on Medicaid paying family members who are caregivers.

State House correspondent Joe Ingles reports.

In its final form, Senate Bill 315 is a complex bill that passed at the last minute in the dead of night.

It passed unanimously in the Senate and only ten representatives voted against it, though many lawmakers said they hadn't had time to digest all that's in it.

But for more than a week, disabled Ohioans and their families had been at the statehouse protesting changes to Ohio Medicaid.

Lawmakers had been hearing a bill to put new rules on home health care providers as an anti-fraud measure, and on June 3rd, the ban on payments for family caregivers was added.

Disabled Ohioans and advocates were already at the meeting to testify, including Jennifer Quiera from the Ohio Olmstead Task Force, a disability advocacy group.

But you really have to study the system.

You have to talk to the people that know the system and get everybody's thoughts on this.

And giving the three minute, five minute testimonies are just simply not enough time.

You have to bring the voices together.

And I know you want to get this done.

And I know you said you've been working on this, but it's not a thing that you can rush through because there will be human damage.

Teacher Justin Martin has cerebral palsy and uses a wheelchair, and has had trouble hiring aides to help him with day to day activities.

And yet, I have to hear folks on this committee saying things like, oh, we're just here to protect the taxpayer.

As if a, I'm not a taxpayer.

I'm trying to work here, but I need to be able to be dressed to do that and be.

I'm fine with safeguarding the taxpayer.

I just think we should start with the taxpayers who can't shower and dress themselves, which will eventually be all of your constituents.

Then on Monday, just as suddenly as it was added, lawmakers struck that ban from the bill.

Dozens who had come to testify against the band thanked lawmakers for removing it, but were frustrated and angry that it was suggested in the first place.

How dare you tell me who could come in my house and care for my child?

I'm not standing here before you telling you thank you like they did.

Thank you.

For what?

I drove 2.5 hours from Cleveland, Ohio with my son, and nobody's here to help me.

Lawmakers say they took to heart what they heard.

The family caregiver piece never was part of the fraud.

And I'm not sure how I got in there while I got in there.

I'm glad that it's out.

As lawmakers raced to wrap up work by the end of the week.

Elements of that Medicaid bill that had more widespread support were rolled into another anti-fraud bill, this one requiring electronic chips in Ate cards used by people in the Snap or food stamp program.

Republican Representative Brian Stewart says the final version of the bill includes increased penalties for Medicaid fraud, electronic video verification, inspections and more.

By trimming the bill down to the things where we agreed on the most, we have a pretty tight product.

Democratic representative bride Rose Sweeney says it appears that family caregivers are not hurt in this bill, but she admits there are some things she doesn't like in it.

Going through this process, I can say that I was genuinely bewildered by some of the shortcomings and gaps within Medicaid.

Lawmakers on both sides of the aisle say they've learned a lot.

I think the way things have gone over the last week, more people are aware of what Medicaid is operating like in the real world.

I think people have a better understanding of the things that parents and caregivers and recipients are dealing with.

I think it's going to make the program better overall, and I think it's helped us do a better job of being able to catch fraud and make sure that we have tighter controls, and that knowledge will come in handy because Stewart says everything lawmakers are doing with Medicaid is up for discussion early next year for the coming two year state budget.

Joe Ingles, Statehouse News bureau.

Medicaid is by far the largest expenditure in the state budget, with federal and state money adding up to around $45.3 billion this fiscal year and nearly $48 billion next year.

There are more than 2.8 million people in Ohio Medicaid, with 40% of those kids under 18 and another 9% over 65.

It's huge, complicated and bureaucracy filled program that often is difficult to learn about and understand.

I talked with Tara Britton of the center for Community Solutions, a think tank that analyzes economic, health and social policy and has long been supportive of Medicaid as a critical safety net me.

So the ban on Medicaid payments for family caregivers did not go through, but there are still questions about the services that those people provide and whether they're worth what the state is paying for them.

I recall the chair of the House Medicaid Committee saying at one point, Jennifer Gross, saying at one point was it proposed and proposition to the people of Ohio paying the bill that in order to keep people in their homes, regardless of their diagnosis, that it would be less expensive to the state than putting them in the long term care?

And you believe that in most, if not all cases, that it is less expensive to apply for all these waivers.

Is it less expensive to pay home health care providers, family members rather than putting people in long term care facilities?

It is.

Yes, it is cheaper.

It is also largely what folks want to do stay in their communities, stay in their own homes, stay with their families and friends.

We have seen data for a long time showing us that it's cheaper.

HPO, the Health Policy Institute, of recently said that it's about $12,000 a year to have someone in home and community based setting.

There is also a requirement when you when the state applies for these waivers, that it is at least cost neutral.

And so when they're suggesting to the federal government, hey, we're going to change how we do this, we're going to waive a portion of the existing law to say, hey, we want to try it this way.

See if it works better.

It has to at least be the same price or cheaper to the feds and the state in order to do it this way.

And so we do know that it is cheaper.

And it's what people want.

You have some data that says 1 in 4 Ohioans are caregivers.

There are 7000 paid family caregivers on Medicaid getting Medicaid payments in Ohio.

So that implies most people are not right.

Most people are providing this care as a part of their the course of their week, and they're not being paid.

And sometimes they're giving up hours at work in order to do this.

Our, you know, making it work within their families lives and schedules.

And we've seen a lot of folks in sort of that the sandwich caregiver.

So caring for someone older and still caring for younger children at home.

Now there are elements of House Bill 785 that were rolled into Senate.

I'm sorry I try that in.

There are elements of House Bill 705 that were rolled into Senate Bill 315.

Obviously, the paid Family Caregivers band was not one of those, but there are some new rules on home health care providers in general, for instance, electronic visit verification.

It used to be that GPS wasn't required.

The person receiving the care had to sign off on allowing GPS, and now this will require GPS check in for home health care providers.

Is there a concern that that's going to affect, or any of these changes is going to affect the care that these people are providing to folks who need it?

I think there are still parts of this that remain to be seen.

We know that some changes to the electronic visit verification or EV, have been changed in what recently happened, but this is a topic we've been talking about for a long time.

We had a plan, and I think for different reasons, the plans throughout the years have not been fully implemented.

There have been issues raised during implementation that said, hey, you know, we live in a rural area, we don't have cell service or coverage, and that makes it really hard to be specific on the times you check in and check out some of the advocates who very, you know, bravely came and told their stories at the state House these last few weeks have shared that, you know, what happens when you're five minutes from the end of your shift or the end of your allowable hours and someone has an emergency, or someone falls, or that's right when they need some assistance with their activities of daily living, it's really difficult to say, like, well, I'm going to check out now, but I'm going to stay and keep help.

Like, you're not going to leave someone there.

So there's just some some tricky things to work out.

I will say that one of the big changes made in this version was to carve out the live in caregivers from the GPS piece, which I know was something that was raised during testimony and obviously is particularly challenging to say, like, hey, I was there providing services or not.

If you live there, it's just tricky.

But there is fraud in the Medicaid program.

I mean, nobody is disputing that.

And it's been said that it's easier to try to or more more cost effective to try to stop fraud on the front end to stop it, rather than try to collect it once it's happened.

Yes, yes.

So I think in some regards, this sort of GPS tracking, making sure folks are where they say they are can help with some of that.

It's really just what does it look like to implement it.

And those have been the challenges throughout the years as we've tried to do this right, in terms of protecting taxpayers from any of their dollars going toward fraud, but at the same time protecting people who need services.

Now, the whole discussion about fraud, like you said, has been going on for a while.

The whole discussion about Medicaid in general.

But there was this report from the Daily Wire that really targeted home health care providers in Ohio in 2024, saying hundreds of millions of dollars in fraud was committed by these folks that had Republican candidate for governor, Vivek Ramaswamy, talking about the things that he wants to implement.

If he wins, he says he wants to ask the federal government to return $0.65 for every dollar of Medicaid fraud found in Ohio, as opposed to the $0.35 on the dollar that is returned.

Now.

He said he wants to flip the math and reverse the incentives.

He wants to set a target of 10% savings for Medicaid spending in waste, fraud and abuse, which will return more than $3 billion to Ohio.

That all sounds good.

Is there an issue with that?

We still have questions about it.

So I would start by saying the reason that the split is currently that 65% goes to the federal government and 35% of, you know, returns come to the state, is that that's the percentage that those entities pay for.

Now, the feds on, on average, pay for 65% of the Medicaid costs.

The state pays for 35%.

So that's why the dollars come back in that way to flip that.

And I know the the candidate use Tennessee as his example.

You know, Tennessee has a much smaller Medicaid program.

They don't have a medicaid expansion program.

So I just have questions about what that design looks like in Ohio versus other states who've done that.

I think there are always ways to be more intentional and also creative with making our maximizing our Medicaid investment, but still have some questions about what that plan looks like.

Do you think that waste, fraud, and abuse in the Medicaid program adds up to $3 billion?

We haven't seen the data directly from that Daily Wire report that I think is sort of informing that that number.

So I still have questions about that as well.

I also noted that Medicaid enrollment has not gone up as fast as Medicaid spending.

Has.

He cited as an example, about 2.9 million people enrolled in Medicaid ten years ago.

Now, three little over 3 million people enrolled in Medicaid now.

But he says Medicaid expenditures are up from $27 billion to $47 billion over that same time period.

Why is that?

Does that suggest there's a problem in Medicaid?

I think that suggests that everything costs more, and the cost of things in health care are even more expensive.

We've also seen a lot of evolution in treatment that, you know, we we are the innovators in this country.

And so things a lot of times cost more at the beginning when we are looking at new classes of medications, things that help keep people healthier, do more sort of preventive care, sometimes those costs more up front.

I would also say that increasing access to services, which is something that folks who are covered in the public systems and also the private systems talk a lot about making sure we have access, means we have to look at increasing the number of providers may mean that folks are just seeking more services because, hey, there's access.

I need to take care of these things.

And so I think it's a multitude of of factors that is increasing the cost of Medicaid.

Medicaid really doesn't see as large of a rate of growth as private health insurance in terms of premiums and sort of the core cost of the program.

So that rate of growth is about half of the rate of growth in the private health care system, at least if you look at kind of Ohio's data compared to some of what's happening in the private system.

So it's a multitude of factors.

Always good to keep looking at it, though.

Back to the $3 billion that Ramaswamy says he wants to get back to Ohio, and he said he wanted to use it to offset Ohioans health care costs, for instance, copay assistance, reducing health insurance premiums, increasing the value of health savings accounts.

Does the money right now that comes back to Ohio from the federal government from found fraud doesn't since that came from Ohio Medicaid, doesn't it go back to Ohio Medicaid?

That would be my initial inclination as well, that, you know, you'd reinvested into the system.

But I think, again, there are these creative ways that we can look at connecting what happens in the public and private system.

Certainly, the overall economics tell us that it is all connected when folks are, you know, seeking care more in emergent, expensive settings, that increases costs for us all.

And so if there is some kind of continuity that we can create between Medicaid and the private system, and if it is some sort of creative way to, you know, invest in reducing overall health care costs, that might mean that someone who is, you know, on benefit cliff between Medicaid and private coverage, if they can get some more assistance by moving in, once they move into private coverage, that makes their chronic condition more affordable.

Maybe there is some connection between the Medicaid and the private system.

Should the state be more aggressive in going after fraud?

And is there a concern that if the state does get more aggressive, that some people who are not committing fraud, but are doing things that maybe some folks feel are not useful?

I mean, I heard in one of the committee meetings someone talking about family members who are paid to care for family members being kind of paid to hang out with grandma, you know, that to some people sounds like abuse, but it's not fraud.

Do you do you feel the state should be more aggressive in going after all of this?

From the testimony we heard in this sort of these last 4 or 5 weeks while we've been really, you know, talking a lot about this issue, we heard from the state attorney general's office that they are often, you know, number one.

Number two, number three, in the country of going after and prosecuting fraud in the Medicaid system, they have, you know, I think you could classify it as really hyping up their the Fraud investigation unit at the AG's office.

So I think the state is pretty aggressive when they see it and know about it.

So there are some components of what happened this week in the law change that I think might make it a more streamlined process for folks to report if they suspect fraud.

And then I think what you're talking about in these sort of what folks might view as waste or abuse category, I want us to be careful in thinking about personal care services and that sort of social aspect of personal care that is part of the overall care plan.

And so, you know, you're kind of thinking about, well, should we be paying for someone to hang out with someone that is a part of an overall care plan?

It is not that someone is.

That's the only service they're connecting with them on, but socialization and making sure that folks have a sort of community social touchpoint is really important as people age and are potentially isolated in their communities.

And so we know from lots of research on, you know, an aging population that that those community social supports are vital to keep keeping people physically and mentally healthy.

So I think it's it's important.

Let's have a conversation about how it fits into the overall sort of care plan.

But doing something really rushed in these last few weeks would have been, you know, kind of a myopic view of, of these services, the so-called One Big Beautiful Bill act cut federal spending on Medicaid also would implement work requirements, which the feds say will save almost $392 billion over the next ten years.

Both candidates for governor say they also support work requirements.

It's a popular idea in general, that's 80 hours of work, job training, volunteering or caring for a family member per month.

What's wrong with work requirements?

There are lots of folks working in the Medicaid.

We're talking about the Medicaid expansion population.

So these are the folks that gained coverage after the Affordable Care Act and had no other means to coverage prior to that.

And so most of those folks are working their employers.

Either they're working in a place that doesn't provide, isn't required to provide health insurance, or they're working a few different part time jobs to kind of piece that together.

Ultimately, those savings, the 392 billion over, over that time period are going to result from folks losing coverage, likely because of administrative barriers, not necessarily because they're not meeting a requirement.

There are going to be a lot of administrative steps to monitoring that folks are working.

If folks are exempt from the work requirement, understanding why and proving it, we just got some guidance from the federal government last week that is raising some questions for us all around, what it means for folks who have a medical frailty issue and would be exempt.

But what does it look like to prove that?

Do you have to have, you know, signed documentation?

How frequently do you have to do that?

What does it mean to be in recovery from substance use disorder?

Lots and lots of questions.

And really, it will result in folks losing coverage because of bureaucracy and red tape, rather than the fact that they're not meeting the requirements of the program.

And finally, I want to ask you, House Bill 795, those elements, without the ban on paid caregivers for family members, without that were rolled into Senate Bill 315, which is a bill that requires electronic chips in ET cards that are used by people in the Supplemental Nutrition Assistance Program, the Snap program.

How does the center for Community Solutions view that particular idea?

We're very excited that the state is investing in chip cards for staff.

That is, the number one cause of fraud in the Snap program is folks getting their benefits stolen off of cards because they haven't been secure.

So the changes that were made to this bill ultimately sort of split up the policy and the money into two separate bills.

But the state will begin investing in when new applicants come through for Snap, that their cards will have a chip in them, which makes it, you know, the the systems that the criminals have in place to steal those benefits will not work on a chip card.

Britton says she is very supportive of the initial concept of Senate Bill 315, which now includes the Medicaid home health care provider changes.

It's the idea of putting electronic chips into cards used by Snap recipients.

Britton says the leading cause of fraud in the Snap program is benefits being stolen because the cards aren't secure.

And that is it for this week.

For my colleagues at the state House News Bureau of Ohio Public Media.

Thanks for watching.

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Support for the Statehouse News Bureau comes from the law offices of Porter, Wright, Morris and Arthur LLP.

Porter Wright is dedicated to bringing inspired legal outcomes to the Ohio business community.

More at Porter Wright.com.

Porter Wright.

inspired every day.

And from the Ohio education Association, representing 120,000 educators who are united in their mission to create the excellent public schools every child deserves.

More at OHEA.org