The Ohio Academy of Family Physicians (OAFP) advocacy team monitors healthcare related legislation, rule changes, and legislative updates for Ohio’s family physicians.
To access the OAFP Bill Tracker, visit the OAFP Public Policy webpage and click on the Bill Tracker icon.
Read on for this week’s updates and contact Advocacy Coordinator Kaela Springhetti with questions or for ways to get involved.
American Academy of Family Physicians Summary on the “Big Beautiful Bill”
Source: American Academy of Family Physicians
The American Academy of Family Physicians (AAFP) has been closely following many provisions in the One Big Beautiful Bill Act that they anticipate will have an impact on members and their patients and communities. Below is a summary of many of those provisions in the Senate-passed version of the bill.
- Work Reporting Requirements: Beginning in 2027, requires states to condition Medicaid eligibility for individuals ages 19-64 applying for coverage or enrolled through the Affordable Care Act (ACA) expansion group (or a waiver) on working or participating in qualifying activities for at least 80 hours per month. The legislation includes a list of exempted individuals, such as parents of children under 14 years, caregivers, individuals with a substance use disorder in treatment, and others. It also specifies that if a person is denied or disenrolled due to work reporting requirements, they are also ineligible for subsidized Marketplace coverage. States are not able to waive these requirements.
- Eligibility Verification: Requires states to conduct eligibility redeterminations at least every six months for Medicaid expansion adults.
- Retroactive Coverage: Limits retroactive coverage to one month prior to application for coverage for expansion enrollees and two months prior to application for coverage for traditional enrollees.
- Provider Taxes: Prohibits the implementation of new provider taxes across states, and gradually phases down existing provider taxes in expansion states to 3.5% by Fiscal Year (FY) 2032 (in comparison to the current limit of 6%). The new limit applies to taxes on all providers except nursing facilities and intermediate care facilities, and also applies to local government taxes in expansion states.
- State Directed Payments: Directs Health and Human Services (HHS) to revise state directed payment regulations to cap the total payment rate for inpatient hospital and nursing facility services at 100% of the Medicare payment rate for states that have expanded Medicaid and at 110% of the Medicare payment rate for states that have not expanded. It does grandfather state directed payments higher than these rates that were submitted prior to enactment of the bill for rural hospitals and prior to May 1, 2025, for all other providers.
- Rural Health Transformation Fund: Establishes a rural health transformation program that will provide $50 billion in grants to states between FY 2026 and 2030, to be used for payments to rural healthcare providers and other purposes. Uses of funds include promoting care interventions, paying for healthcare services, expanding the rural health workforce, and providing technical or operational assistance aimed at system transformation. While rural health clinics and community health centers are recognized in the list of “eligible facilities” for payment, standalone physician practices are not.
- Family Planning Provider Funding Restrictions: Prohibits Medicaid funds to be paid to providers that are nonprofit organizations, essential community providers primarily engaged in family planning services or reproductive services, provide for abortions outside of the Hyde exceptions and received $8,000,000 or more in payments from Medicaid in 2023. This provision is largely targeted at Planned Parenthood.
- Cost Sharing Requirements: Requires states to impose cost sharing of up to $35 per service on expansion population adults with incomes within 100-138% of the federal poverty line. It explicitly exempts primary care, mental health, and substance use disorder services from cost sharing, maintains existing exemptions of certain services from cost sharing, and limits cost sharing for prescription drugs to nominal amounts. It also excludes services provided by federally qualified health centers, behavioral health clinics, and rural health clinics.
- HSA-Qualified Marketplace Plans: Treats individual market bronze and catastrophic plans as a High Deductible Health Plan (HDHP) that can be paired with a health savings account.
- Direct Primary Care (DPC) Arrangements: Allows individuals with health savings accounts (HSAs) to use those funds to pay for DPC arrangements. This has been a policy that the AAFP has long supported and advocated to both the Internal Revenue Service and Congress to enact.
- Telehealth Safe-Harbor for HDHPs: Permanently extends a COVID-era flexibility that allows sponsors of HDHPs to provide pre-deductible coverage of telehealth services for enrollees.
- Special Enrollment Periods (SEP) and Tax Credit Eligibility: Bars anyone who enrolls in a plan via a non-Qualifying Life Event SEP from receiving either premium tax credits or cost-sharing reductions (CSRs) beginning in 2026.
- Pre-Enrollment Verification of Eligibility for Premium Tax Credit: Requires pre-enrollment verification of eligibility, in comparison to current law where returning enrollees who take no action during open enrollment are auto-renewed into the same or similar plan.
- ACA Marketplace Coverage Eligibility for Lawfully Present Immigrants: Restricts subsidized ACA marketplace coverage eligibility for certain immigrants including lawfully present immigrants who are lawful permanent residents (LPRs or “green card” holders), Compact of Free Association (COFA) migrants residing in the U.S., or certain immigrants from Cuba and Haiti, eliminating eligibility for many lawfully present immigrants including refugees, asylees, and people with Temporary Protected Status beginning Friday, January 1, 2027.
- Medicare Physician Payment Increase: Provides a temporary one-year increase of 2.5% to Medicare physician payment rates for 2026.
- Medicare Eligibility for Certain Populations: Restricts Medicare eligibility to U.S. citizens, green card holders, certain immigrants from Cuba and Haiti, and people residing under the Compacts of Free Association. Eliminates Medicare eligibility for people not included in the above groups, such as those with temporary protected status and refugees and asylees, and terminates benefits for those no longer eligible 18 months after enactment of the legislation.
- Eligibility and Enrollment Final Rule: Delays implementation of the rule until Sunday, October 1, 2034, except provisions that have already taken effect, including auto-enrollment of certain SSI recipients into the Qualified Medicare Beneficiary (QMB) group.
- Nursing Home Staffing Final Rule: Prohibits the Secretary of Health and Human Services from implementing, administering, or enforcing the minimum staffing levels required by the final rule until Sunday, October 1, 2034.
- Changes to the Supplemental Nutrition Assistance Program: Prevents any re-evaluations to SNAP benefits beyond inflation, which would not allow SNAP benefits to be updated based on changes to nutritional guidelines. It also implements state-federal cost sharing for states with payment error rates over 6%, which would apply to 47 states.
- Caps on Federal Student Loan Borrowing: Eliminates Grad PLUS loans and caps unsubsidized professional (e.g., medicine) borrowing at $50,000 per year ($200,000 lifetime). The AAFP, both individually and alongside other stakeholders, has strongly opposed this and other student loan-related provisions and expressed strong concern about their potential to further decimate the primary care workforce.
Several other concerning provisions were ultimately removed from the final text, in part thanks to the advocacy of family physicians across the country. This includes recension of the proposal to exclude medical and dental residents from participating in the Public Service Loan Forgiveness Program (PLSF) and banning Medicaid funds from being used to pay for gender-affirming care services for any individuals.
The AAFP also actively opposed policy within various drafts of H.R. 1 that would have undermined the financial viability of independent practices. The House passed a version of the bill that would have disallowed independent physician practices (and other small businesses deemed as “specified service trade or business”) from being able to take advantage of state work arounds for State and Local Income Tax (SALT) deductions if the business were also using small business deductions on pass-through income. The AAFP joined numerous other medical associations in opposing this specific provision in that it would have a detrimental effect on our already diminishing independent practice model for all physicians. This provision was stripped out of the final version.
‘Big Beautiful Bill:’ Cuts to Medicaid Could Reduce Billions in Health Spending Power at Hospitals Statewide
Source: Dayton Daily News
More than 760,000 Medicaid recipients in Ohio are at risk of losing coverage, and hospitals across the state could lose billions of dollars over the next decade, now that Congress has approved the federal spending bill.
The One Big Beautiful Bill Act, nicknamed the “Big Beautiful Bill,” includes sharp cuts to healthcare spending via changes to Medicaid, which Congress approved last week.
Nearly 3 million Ohioans receive Medicaid coverage, according to the Ohio Department of Medicaid. As of May, more than 760,000 Ohioans receive coverage through the expansion of Medicaid.
The One Big Beautiful Bill Act will reduce federal Medicaid payments to states by approximately $1 trillion over the next 10 years, according to the Congressional Budget Office.
The federal spending bill includes reductions in Medicaid spending for the expansion group that, when combined with a “trigger” clause in Ohio’s latest budget bill, will remove the expansion group of Medicaid, of which there at more than 760,000 Ohioans who receive healthcare coverage through that expansion of Medicaid.
The trigger clause allows the state to terminate Medicaid coverage for the expansion group, also known as Group VIII, if the federal matching rate falls below 90%.
Read the full article in The Dayton Daily News.
Foreign Medical Residents Fill Critical Positions at U.S. Hospitals, but are Running into Visa Issues
Source: Dayton Daily News
Some hospitals in the U.S. are without essential staff because international doctors who were set to start their medical training this week were delayed by the Trump Administration’s travel and visa restrictions.
It’s unclear exactly how many foreign medical residents were unable to start their assignments, but six medical residents interviewed by The Associated Press say they’ve undergone years of training and work only to be stopped at the finish line by what is usually a procedural step.
“I don’t want to give up,” said a permanent Canadian resident who matched to the University of Pittsburgh Medical Center Harrisburg but had her visa denied because she is a citizen of Afghanistan. She requested to remain anonymous for fear of reprisal. “But the situation also seems so helpless.”
Initially, the medical community was worried that hundreds of positions — many in hospitals in low-income or rural areas of the U.S. — could be affected. The pause on interviews for J-1 visas for approved work or study-related programs was lifted in mid-June.
The national nonprofit that facilitates the residency match process said the visa situation is resolving, but it will take weeks to know with confidence how many medical residents have had the start of their careers derailed because they got their visa too late or were blocked by President Donald Trump’s travel ban on 12 countries, according to people who coordinate the residents’ training.
Four foreign medical residents told the AP that U.S. embassies have been slow to open up interview slots — and some have not opened any.
“You lose out on the time you could have used to treat patients,” said one resident from Pakistan, who matched to an internal medicine program in Massachusetts and requested to remain anonymous for fear of reprisal.
Read the full article in The Dayton Daily News.
Ohio’s Medicaid Expansion Group Survives Federal Budget, but Cuts Still Coming
Source: Ohio Capital Journal
A provision in the new state operating budget that would eliminate Ohio’s Medicaid expansion group may not see the light of day, based on the federal budget just passed by Congress.
But even with the expansion group surviving budget talks, impacts to Medicaid in Ohio are still on the horizon from the budget reconciliation bill, according to analysts and advocates.
The state operating budget was passed at the end of June and signed by Governor Mike DeWine on June 30. The budget included a provision that Gov. DeWine himself had written into his executive budget proposal, and which survived a Senate and House vote, along with joint conference committee debate in the Statehouse.
That provision would eliminate the state’s Medicaid expansion group, also called Group VIII, if the federal medical assistance percentage (or FMAP) for that group, which is the contribution Congress gives to the state to help with Medicaid, drops below 90%. If the FMAP drops even 1% on the group, the expansion would be dropped from the Medicaid rolls in Ohio.
But it seems the expansion group is safe for now, as congressional plans to lower the FMAP on expansion groups are specific to states who spend their own money to cover immigrants lacking “qualified status” under Medicaid. Immigrants without legal status are already ineligible for federally funded Medicaid.
“Despite early conversations and, kind of, conjecture, I think that advocates did a pretty solid job to make it clear that any changes to the FMAP would be devastating,” said Natasha Murphy, health policy director for the Center for American Progress.
Medicaid expansion came to the states as part of the Affordable Care Act, which expanded program eligibility to 138% of the federal poverty level, an expansion that was bolstered by a Supreme Court decision. The expansion came to Ohio under Republican Gov. John Kasich.
Read the full article in The Ohio Capital Journal.