Immediate Suspension of Payments for Ohio Medicaid Home Health and Waiver Services
As part of a coordinated national and state effort to address alleged Medicaid fraud in Ohio, the Ohio Department of Medicaid (ODM) has immediately suspended payments for Ohio Medicaid home health and waiver services provided by 49 home health agencies. The payment suspensions, which appear to be effective Wednesday, June 3, 2026, were issued pursuant to an emergency rule enacted by ODM the day prior. Importantly, this emergency rule purports to allow ODM to suspend Medicaid payments without suspending the organizations’ Medicaid provider agreements. See Ohio Admin. Code § 5160-1-17.51.
The emergency rule permits ODM to suspend payments to providers:
- Upon determining there is a credible allegation of fraud for which an audit or investigation is pending against a provider under the Medicaid program; or
- Upon receiving notice and copy of an indictment that charges a non-institutional provider, its owner or owners, officer, authorized agent, associate, manager, or employee with committing an offense as specified in division (E) of section 5164.37 of the Revised Code.
Based on the language of the emergency rule and communications from Medicaid managed care organizations, providers subject to a payment suspension can, at least for now, continue to provide services to Medicaid beneficiaries. However, these providers will not receive payment for these services during the payment suspension. Please note, providers should be careful to review their specific notice of suspension as it may list additional obligations or restrictions. As of this morning, our understanding is that not all providers who were subject to a payment suspension effective June 3 have received their individualized notice of suspension, but we suspect they will be receiving these notices imminently.
Importantly, providers subject to a payment suspension will have the opportunity to request a reconsideration of their suspension. Instructions for doing so are contained in the ODM notice of payment suspension. If a payment suspension is lifted, we would expect that payments owed to a provider will be released to the provider at the conclusion of the payment suspension. As a result, we would encourage providers to prepare for a significant gap in payment for services rendered during the period of the payment suspension.
If you have questions about how these developments may impact your organization, or your rights relative to the immediate payment suspension, please contact us for guidance.
