Over four months ago, the Ohio Supreme Court issued a unanimous order directing the Ohio Department of Medicaid to correct how it calculated nursing facility Medicaid payment rates.

The Court did not invite further discussion.

It did not suggest a path forward.

It ordered one.

Since then, rates have not been recalculated.

Funds have not been paid.

And providers remain in financial limbo, forced to account for revenues and tax obligations tied to payments that have not yet been made.

At this point, the issue is no longer how Ohio should pay for care.

It is whether a state agency will comply with a final order of Ohio’s highest court.

The Order Was Clear—and Final

After concluding that ODM’s methodology conflicted with governing statute, the Supreme Court directed ODM to calculate rates in accordance with the law as enacted.

ODM sought a stay.

ODM sought reconsideration.

Both requests were denied.

There is no remaining legal ambiguity.

There is no pending appeal.

And while no one—least of all ODM—wants to find itself in contempt of court, continued inaction only sharpens that risk.

Why This Delay Matters

Failure to implement the Court’s order is not a procedural inconvenience. It carries real, compounding consequences.

A Tax Cliff

Providers are being taxed on revenue they have not received. Quality payments that should have flowed months ago remain outstanding, distorting cash flow, financial reporting, and tax obligations.

Financing and Operations

Lenders, bondholders, and boards depend on predictable Medicaid reimbursement. Prolonged uncertainty:

• Complicates refinancing
• Increases borrowing costs
• Forces operational conservatism where investment was the point of reform

Facilities cannot responsibly plan staffing, capital improvements, or wage adjustments based on funds that exist only on paper.

The Quality Signal

Quality incentives are not symbolic. They fund:

• Workforce stability
• Clinical leadership
• Infection control and compliance infrastructure

When those incentives are delayed—or ignored—the system drifts back toward survival mode.

This Is Not a New Dispute

This moment cannot be separated from the broader context.

As ASI detailed in a prior analysis, Governor Mike DeWine repeatedly and publicly championed a restructuring in nursing facility reimbursement—one that would reward high-performing providers and pay for quality rather than merely talk about it.

The provider community took that commitment seriously—and delivered measurable improvement in care.

The Court’s ruling affirmed that this commitment was not merely aspirational; it was written into law.

Turning the Page—But Only After Compliance

It is time to turn the page.

ODM and the provider community ultimately serve the same citizens. Collaboration—not litigation—should define what comes next.

But collaboration requires trust.

And trust requires compliance.

Before Ohio can credibly move forward—before it can debate future reforms or rebuild confidence in its quality framework—ODM must first satisfy its existing legal obligation:

• Implement the Court’s order
• Recalculate the rates lawfully
• Pay what is owed

Ohio set an expectation.

Providers met it.

The Supreme Court enforced it.

Now execution must finally match both the law—and the word that was given.