The Ohio Department of Medicaid has now gone seven months without complying with a unanimous order from Ohio's Supreme Court. That is not a delay. It is defiance.
On September 2, 2025, the Supreme Court of Ohio issued a unanimous ruling directing the Ohio Department of Medicaid to correct how it calculated nursing facility quality incentive payments. The court found that ODM had miscalculated the statutory formula — not by interpretation, but by substituting its own math for the one the General Assembly wrote into law.
ODM sought a stay. The court denied it.
ODM sought reconsideration. The court denied that too.
And then: nothing.
Seven months later, rates have not been recalculated. Payments have not been made. And the Ohio Department of Medicaid has not provided any public timeline for when it intends to comply with the order of Ohio's highest court.
ASI Raised the Alarm. The Press Took It From There.
When we first published on this issue in January — "Ohio's Highest Court Spoke. Medicaid Still Hasn't Acted." — our core concern was simple: a state agency was ignoring a final judicial order, and no one in state government was publicly demanding compliance.
What happened next confirmed that the concern was warranted.
Reporting by The Cleveland Plain Dealer, the Ohio Capital Journal, Dayton Daily News, Gongwer News Service, and McKnight's Long-Term Care News filled in the picture. The facts are now well-documented and not seriously contested by anyone involved.
The court's order was unanimous and final. ODM's motion for reconsideration was denied in November. Rates were not recalculated when the new rate period began on January 1, 2026 — meaning ODM chose to extend the underpayment into a new year rather than begin compliance. Providers have received no timeline, no plan, and no payment.
As Ohio Health Care Association CEO Scott Wiley told The Cleveland Plain Dealer: "To date, they have not provided any indication of when — or if — they intend to comply."
That sentence deserves to be read slowly.
The People Responsible Have Spoken. What They Said Is Telling.
When Governor DeWine was asked directly about the delay, he told reporters: "We're talking to members of the legislature. We will be dealing with this. We will, you know, follow the law."
"Follow the law" should not require a conversation with the legislature. The Supreme Court already resolved that question.
When ODM Director Scott Partika was pressed by Rep. Tim Barhorst during a joint Medicaid committee hearing — Barhorst said he had received "numerous calls from nursing homes" in his district and asked for a status update and timeline — Partika replied: "I don't have any particular timeline of when to expect that."
Senate Finance Committee Chair Sen. Jerry Cirino, R-Kirtland, told Gongwer News Service he was "surprised that there was not more of a rush to settle the issue." He said he could not identify any legislative levers available to compel the executive branch to act.
House Finance Chair Rep. Brian Stewart, R-Ashville, told Gongwer that compliance "is a matter for the executive branch to figure out" and that he did not anticipate additional legislative appropriation.
In other words: everyone agrees ODM owes the money. No one has committed to a timeline for paying it.
The Consequences Are Not Abstract
The harm accumulating during this delay is real and compounding.
Providers operating on an accrual tax basis may be required to recognize as taxable income funds they have never received — because the Supreme Court's ruling is final and the legal uncertainty has been removed. As reported by the Ohio Capital Journal, this creates the possibility that providers face tax obligations on money the state has not paid.
Ohio Health Care Association CEO Scott Wiley described the impact to McKnight's Long-Term Care News: "These aren't future dollars — they are earned payments, now two years overdue, that supported real staffing, real investments and real residents."
A letter to ODM Director Partika — signed by four state senators including Senate Majority Whip George Lang and Senate President Pro Tempore Bill Reineke — noted that providers committed these anticipated funds to workforce development and employee wage increases in 2023, and that Medicaid reimbursement already falls approximately $60 per day below the actual cost of care, based on recent analysis from Plante Moran.
The senators also noted something that should not be lost in the arithmetic: approximately 64.6% of the owed payments are federally reimbursable through Medicaid matching funds. The actual state share is roughly 35.4% of the total obligation. ODM is defying a court order while Ohio's Rainy Day Fund carried more than $3.8 billion through the end of FY 2025.
This Is What ODM Originally Promised
Governor DeWine, when he signed the 2023 budget legislation that created this quality incentive framework, made the logic explicit. His own words:
"If a nursing home takes care of its residents exceptionally well, well then, they will be rewarded with more funding."
He described the incentives as "real rewards" — not aspirational rewards, not contingent rewards, not rewards subject to administrative discretion. Real ones.
The Supreme Court agreed that those rewards were written into law. Providers delivered the quality. The court ordered the payment.
Seven months later, the reward still hasn't arrived.
What Comes Next
This is no longer a reimbursement dispute. It has become a constitutional crisis.
The General Assembly wrote a law. The Supreme Court enforced it. And a state agency — with full knowledge of both — has spent seven months defying it.
That is not administrative delay. That is one branch of Ohio government refusing to follow the law.
The contempt power exists precisely for this scenario. Courts do not issue orders as suggestions. A writ of mandamus is a command — directed at a specific agency, requiring a specific act. When that command goes unanswered for seven months, the question is no longer whether ODM is slow. The question is whether ODM considers itself bound by Ohio law at all.
