Ohio nursing facilities now have updated information regarding the calculation of quality payments under HB 479. The September 30, 2026 calculation shows materially higher statewide amounts incorporated into the quality-point methodology than the original calculation, with the revised pool nearly tripling in most rate periods.
Background: Why the Original Calculation Was Wrong
This reconciliation traces back to a dispute over how Ohio applied a 2023 rebasing increase to nursing facilities’ quality incentive payments. State law requires that 60% of the increase in facilities’ direct care rate from rebasing flow into the quality incentive payment pool. The Ohio Department of Medicaid (ODM) applied that 60% to the price, the pre-case-mix cost figure, rather than to the rate, the case-mix-adjusted cost per unit that nursing facility groups argued the statute actually specified. That distinction mattered enormously: applying the increase before case-mix adjustment produced a dramatically smaller pool than applying it after.
OHCA and LeadingAge Ohio challenged ODM’s interpretation, and in September 2025 the Ohio Supreme Court ruled unanimously in the providers’ favor, finding that ODM’s approach “dramatically shortchanged” the increase the legislature intended. The court ordered ODM to recalculate the payments using the correct formula. Ohio lawmakers addressed the dispute in two steps: House Bill 184, effective March 20, 2026, amended the underlying statute (Ohio Revised Code 5165.26) to replace the disputed term “rate” with “cost per case-mix unit,” codifying the provider-favored interpretation going forward and stopping further underpayment from accruing. House Bill 479, signed by Governor DeWine on June 25, 2026, then appropriated the $875 million discussed below to cover the shortfall that had already accrued for the 7/1/2023 through 2024–2025 budget cycle rate periods, the six periods shown in the tables that follow. The September 30, 2026 narrative and tables are ODM’s resulting recalculation under the corrected formula.
How the Quality-Point Calculation Works
The calculation uses Medicaid days multiplied by a facility’s average quality points to determine “point days.” Those point days serve as the denominator for determining the value of each quality point. The statewide dollar pool, 60% of the change to the direct care rate, serves as the numerator. Dividing the pool by total point days produces the value per quality point applied to every facility’s payment for that rate period.
Pool and Value per Quality Point by Rate Period
The table below reflects the full detail behind the revised calculation, now showing the underlying Medicaid days, point days, and dollar pool for both the original and revised figures, not just the resulting per-point values:
| Rate Period | Medicaid Days (Point Days Calc.) | Point Days (Days × Avg. Pts.) | ORIG. 60% Change to DC Rate | ORIG. Value/Pt. | REVISED 60% Change to DC Rate | REVISED Value/Pt. |
|---|---|---|---|---|---|---|
| 7/1/2023 | 14,450,060 | 268,602,027 | $169,922,242 | $1.88 | $458,227,220 | $2.94 |
| 1/1/2024 | 14,450,060 | 268,602,027 | $169,922,242 | $1.88 | $458,227,220 | $2.94 |
| 7/1/2024 | 15,395,728 | 435,685,656 | $169,922,242 | $1.20 | $487,606,721 | $1.91 |
| 1/1/2025 | 15,395,728 | 435,685,656 | $169,922,242 | $1.20 | $487,606,721 | $1.91 |
| 7/1/2025 | 14,586,497 | 443,295,012 | $169,922,242 | $1.14 | $492,532,594 | $1.87 |
| 1/1/2026 | 14,586,497 | 443,295,012 | $169,922,242 | $1.14 | $492,532,594 | $1.87 |
Days and Settlement Amounts by Rate Period
Alongside the revised per-point values, ODM published the Medicaid days and resulting settlement amount used to true up each rate period:
| Rate Period | Medicaid Days (Settlement Calc.) | Settlement Amount |
|---|---|---|
| 7/1/2023 | 7,465,711 | $157,633,838 |
| 1/1/2024 | 7,473,359 | $169,443,288 |
| 7/1/2024 | 7,576,982 | $151,537,563 |
| 1/1/2025 | 7,597,582 | $163,422,443 |
| 7/1/2025 | 7,611,865 | $177,222,460 |
| 1/1/2026 | 3,801,763 | $104,030,244 |
What the Revised Numbers Show
For the July 1, 2023 and January 1, 2024 rate periods, the statewide amount representing 60% of the change to the direct care rate increased from approximately $169.9 million to $458.2 million, pushing the value per quality point from $1.88 to $2.94. Later rate periods reflect the same pattern: the dollar pool for each period grew two-and-a-half to nearly three times over, while point days (the denominator) also grew as more recent periods incorporated higher Medicaid day counts and point averages. Net of both effects, the revised value per point rose by roughly 56% to 64% depending on the rate period:
- 7/1/2023 & 1/1/2024: $1.88 → $2.94 (+56.4%)
- 7/1/2024 & 1/1/2025: $1.20 → $1.91 (+59.2%)
- 7/1/2025 & 1/1/2026: $1.14 → $1.87 (+64.0%)
Summed across all six rate periods, the settlement amounts total approximately $923.3 million, closely corroborating OHCA’s statewide estimate discussed below.
Statewide Funding and Provider Considerations
OHCA indicated that it believes approximately $940 million is available statewide, consisting of $875 million under HB 479 plus an additional $65 million authorized by the Controlling Board. OHCA also cautioned that it had not independently verified every facility-level calculation displayed by ODM.
Providers whose ODM-calculated payment appears materially incorrect should consider consulting their legal and reimbursement advisors. OHCA noted that HB 479 contains language concerning acceptance of payment, satisfaction of the outstanding amount due, and waiver of a contrary legal claim, so accepting a settlement payment is not necessarily a cost-free or reversible decision if a facility later identifies a calculation error.
Payment Timeline
HB 479’s operating appropriations took effect June 24, 2026. For facilities that have not undergone a change of operator or owner since July 1, 2023, the statute requires ODM to issue payment “without delay” once the amount owed is determined, which is the recalculation reflected in the September 30, 2026 narrative and tables above. No separate, publicly announced disbursement date beyond that statutory “without delay” standard has been identified as of this writing, so providers should watch for a specific payment or remittance date from ODM rather than assume one is already set.
Facilities that changed operator or owner between July 1, 2023 and HB 479’s effective date face an added step: the exiting and entering operator or owner must jointly notify ODM of which party is entitled to the payment. If the exiting party no longer exists, the entering party must instead provide ODM a unilateral notice along with proof that the exiting party is gone. If the two parties disagree about entitlement, ODM is barred from releasing payment until it receives a signed agreement from both parties resolving the question. Facilities that underwent a CHOW in this window should resolve that notice requirement now rather than waiting, since it is a precondition to payment, not a formality that follows it.
Disputing the ODM Calculation Before Accepting
HB 479 and the legislative analysis reviewed for this article do not specify a formal window or procedure for a facility to contest ODM’s calculated amount before accepting payment. What the statute does specify is the consequence of acceptance: accepting payment satisfies the outstanding amount due for per-Medicaid-day quality incentive payments and waives any legal claim to the contrary. In practical terms, that means there is no stated cure period after acceptance, so a facility that later discovers a discrepancy in its own Medicaid days, points, or payment calculation may have little or no recourse once it has accepted. Providers who have concerns about their figures should raise them with ODM, and consider consulting legal and reimbursement advisors, before accepting a payment, not after.
A Note on Sourcing
The figures and narrative in this article come from ODM’s “Ohio Nursing Home Quality Calculation Narrative HB 479” document and OHCA’s accompanying clarification, both dated September 30, 2026, not from an independently verified ODM dashboard or filing reviewed directly for this article. OHCA itself cautioned that it had not independently verified every facility-level calculation ODM has displayed, and the background on House Bills 184 and 479 above draws on legislative analyses and contemporaneous reporting rather than the bill text itself. Providers should treat the figures above as a strong starting point for checking their own facility’s numbers, not as a substitute for confirming the final amount directly with ODM.
Key Takeaway
Ohio nursing facility operators should compare their own quality points, Medicaid days, and ODM payment calculation against the applicable rate-period values shown above before evaluating, and especially before accepting, the amount shown on the ODM dashboard.
Sources: Ohio Nursing Home Quality Calculation Narrative HB 479, “Pool and Value per Point Amounts by Rate Period” and “Days and Settlement Amounts by Rate Period,” dated September 30, 2026; OHCA clarification circulated September 30, 2026; Ohio Supreme Court ruling, September 2025 (OHCA and LeadingAge Ohio v. Ohio Department of Medicaid); House Bill 184 (eff. 3/20/2026) and House Bill 479 (signed 6/25/2026) legislative analyses, Ohio Legislative Service Commission; LeadingAge Ohio and Skilled Nursing News reporting on HB 479, June 2026.
