OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 177 Bill Analysis
135th General Assembly
Version: As Introduced
Primary Sponsors: Sens. DeMora and Hicks-Hudson
Effective Date:
Nick Thomas, Research Analyst
SUMMARY
 Establishes and provides for the operation of the Ohio Health Care Plan, providing
universal health care coverage to all Ohio residents.
TABLE OF CONTENTS
Ohio Health Care Plan ..................................................................................................................... 2
Eligibility ...................................................................................................................................... 2
Benefits........................................................................................................................................ 4
Provider participation ................................................................................................................. 5
Procedures to resolve disputes and grievances; appeals ........................................................... 6
Ohio Health Care Board .................................................................................................................. 7
Duties and functions of the Ohio Health Care Board .................................................................. 7
Creation and membership of the Ohio Health Care Board ......................................................... 9
Regional Health Advisory Committee regions........................................................................ 9
Election of representatives to Regional Health Advisory Committees .................................. 9
Regional committees elect representatives to, and advise, Board...................................... 10
Administration of the Ohio Health Care Board ......................................................................... 11
Technical and Medical Advisory Board ......................................................................................... 12
Ohio Health Care Agency .............................................................................................................. 13
Executive Director ..................................................................................................................... 13
The administrator of planning, research, and development .................................................... 14
The administrator of consumer affairs ..................................................................................... 14
The administrator of quality assurance .................................................................................... 15
The administrator of finance ..................................................................................................... 15
June 11, 2024
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Ohio Health Care Fund .................................................................................................................. 16
Liability for service to Ohio Health Care Plan boards and agencies ............................................. 16
Compensation and training for workers displaced by the Ohio Health Care Plan ....................... 17
Funding sources and budget ......................................................................................................... 17
Funding ...................................................................................................................................... 17
Federal financial participation .................................................................................................. 18
Budget ....................................................................................................................................... 18
System budget ...................................................................................................................... 19
Provider and facility budgets ................................................................................................ 20
Capital investment budget ................................................................................................... 21
Purchasing budget ................................................................................................................ 22
Research and innovation budget.......................................................................................... 22
Capital account .......................................................................................................................... 22
Implementation schedule ............................................................................................................. 22
DETAILED ANALYSIS
Ohio Health Care Plan
The bill creates the Ohio Health Care Plan, which is charged with providing universal and
affordable health care coverage to all Ohio residents, consisting of a comprehensive benefit
package that includes benefits for prescription drugs, while simultaneously working to:
 Control health care costs;
 Control health care spending;
 Achieve measurable improvement in health care outcomes;
 Increase all parties’ satisfaction with the health care system;
 Implement policies that strengthen and improve culturally and linguistically sensitive
care; and
 Develop an integrated health care database to support health care planning.
The Ohio Health Care Plan is administered by the Ohio Health Care Agency (see “Ohio
Health Care Agency,” below) under the direction of the Ohio Health Care Board (see “Ohio
Health Care Board,” below).1
Eligibility
All Ohio residents and individuals employed in Ohio, including homeless and migrant
workers, are eligible for coverage under the Ohio Health Care Plan. The bill requires the Ohio
1 R.C. 3920.02(A).
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Health Care Board to establish standards and a simplified procedure to demonstrate proof of
residency. The Ohio Health Care Board also must establish procedures to: (1) enroll eligible
residents and employees, and (2) provide covered persons with identification that providers can
use to determine the individual’s eligibility for health care services.
If waivers are not obtained from the Medicaid and Medicare programs, or whenever a
necessary waiver is not in effect, the Medicaid program, Medicare program, CHIP program, and
Federal Employees Health Benefits program serve as the primary insurance for Ohio’s residents
and workers, and the Ohio Health Care Plan serves as the secondary or supplemental plan of
health coverage. When the Ohio Health Care Plan serves as a secondary or supplemental plan of
health coverage, the Ohio Health Care Plan must not provide coverage to an Ohio resident or
individual employed in Ohio for any covered health care service that the resident or worker is
then eligible to receive under the primary program.
Under the bill, a plan of employee health coverage provided by an out-of-state employer
to an Ohio resident working outside of Ohio serves as the employee’s primary plan of health
coverage and the Ohio Health Care Plan serves as the employee’s secondary plan of health
coverage. The Ohio Health Care Agency must bill out-of-state employers or the employers’
insurers for the cost of covered health care services provided under the Ohio Health Care Plan to
Ohio residents employed by the out-of-state employer when the health care services provided
are covered under the terms of the employer’s plan of employee health coverage. The Ohio
Health Care Plan must reimburse Ohio Health Care Board approved providers practicing outside
of Ohio at Ohio Health Care Plan rates for health care services rendered to a plan participant
while the participant is out of Ohio.
The bill permits any employer operating in Ohio to purchase coverage under the Ohio
Health Care Plan for an employee who lives outside of Ohio but who works in Ohio. The bill also
permits any institution of higher education located in Ohio to purchase coverage under the Ohio
Health Care Plan for a student who otherwise lacks status as a resident of Ohio. 2
Any employer operating in Ohio and providing employees with benefits under a public or
private health care policy, plan, or agreement as of the date that benefits are initially provided
pursuant to the bill, which benefits are less valuable than those provided by the Ohio Health Care
Plan, may participate in the Ohio Health Care Plan, or, alternatively, must provide additional
benefits so that, until the expiration of the policy, plan, or agreement, the benefits provided by
the employer at least equal that amount and scope of the benefits provided by the Ohio Health
Care Plan. If an employer chooses to provide the additional benefits, the additional benefits must
include the employer’s payment of any employee premium contributions, copayments, and
deductible payments called for by the policy, contract, or agreement. The bill exempts employers
from all health taxes imposed under the bill until the expiration of the policy, plan, or agreement,
at which point the employer and the employer’s employees become participants in the Ohio
Health Care Plan. Any person covered by a health care policy, contract, or agreement that has
premiums paid for in any part with public money, including money from the state, a political
2 R.C. 3920.07(A) to (G).
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subdivision, state educational institution, public school, or other entity, is covered under the Ohio
Health Care Plan on the day that benefits become available under the Plan.
Health care insurers, health insuring corporations, and other parties selling or providing
health care benefits, may deliver, issue for delivery, renew, or provide health benefit packages
that do not duplicate the health benefit package provided by the Ohio Health Care Plan, but may
not, except as provided for in connection with the implementation of the Ohio Health Care Plan,
deliver, issue for delivery, renew, or provide health benefit packages that duplicate the health
benefit package provided by the Ohio Health Care Plan.3
Under the bill, any individual who arrives at a health care facility unconscious or otherwise
unable due to their mental or physical condition to document their eligibility for coverage is
presumed to be eligible for coverage under the Ohio Health Care Plan.4
Benefits
The bill requires the Ohio Health Care Board to establish a single health benefits package
that includes all of the following:
1. Inpatient and outpatient provider care, both primary and secondary;
2. Emergency services, as defined in Ohio’s Sickness and Accident Insurance Law, 24 hours
per day, on a prudent layperson standard. Residents who are temporarily out of state may
receive benefits for emergency services rendered in that state. The Ohio Health Care
Agency must make timely emergency services, including hospital care and triage,
available to all Ohio residents, including all residents not enrolled in the Ohio Health Care
Plan;
3. Emergency and other transportation to receive covered health care services. The Ohio
Health Care Plan must reimburse independent transportation providers who provide
transportation to covered health care services on a fee-for-service basis. Fee schedules
for covered transportation may take into account the recognized cost differences among
geographic areas. For this purpose, a transportation benefits account is created within
the Ohio Health Care Fund (the fund) (see “Ohio Health Care Fund,” below);
4. Rehabilitation services, including speech, occupational, and physical therapy;
5. Inpatient and outpatient mental health services and substance abuse treatment;
6. Hospice care;
7. Prescription drugs and prescribed medical nutrition;
8. Vision care, aids, and equipment;
9. Hearing care, hearing aids, and equipment;
3 R.C. 3920.12.
4 R.C. 3920.07(H).
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10. Diagnostic medical tests, including laboratory tests and imaging procedures;
11. Medical supplies and prescribed medical equipment, both durable and nondurable;
12. Immunizations, preventive care, health maintenance care, and screening;
13. Dental care;
14. Home health care services.5
The bill prohibits the Ohio Health Care Plan from excluding or limiting coverage of its
participants’ preexisting conditions. Participants have free choice between the providers eligible
to participate in the Ohio Health Care Plan. Residents enrolled in the Ohio Health Care Plan are
not subject to copayments, point-of-service charges, or any other fee or charge. No provider may
directly bill an enrollee for a covered health care service.6
The Ohio Health Care Board, with the consent of the Technical and Medical Advisory
Board (see “Technical and Medical Advisory Board,” below), may remove or exclude
procedures and treatments, equipment, and prescription drugs from the Ohio Health Care Plan’s
benefit package that the Board finds unsafe, experimental, of no proven value, or that add no
therapeutic value. The Ohio Health Care Board must exclude coverage for any surgical,
orthodontic, or other medical procedure, or prescription drug, that the Technical and Medical
Advisory Board determines was or will be provided primarily for cosmetic purposes, unless
required to correct a congenital defect, to restore or correct disfigurements resulting from injury
or disease, or that is determined to be medically necessary by a qualified licensed provider.7
Providers may not be compelled by the Ohio Health Care Agency to offer any particular
service, as long as the provider does not discriminate among patients in providing health care
services, and the bill also prohibits the Ohio Health Care Plan and its participating providers from
discriminating on the basis of race, color, religion, national origin, sexual orientation, health
status, employment status, or occupation or sex, military status, disability, or age as defined in
the Ohio Civil Rights Law.8
Provider participation
The bill permits all providers to participate in the Ohio Health Care Plan. As used in the
bill:
1. “Provider” means a hospital or other health care facility and health care personnel
authorized to furnish health care services in Ohio;
5 R.C. 3920.08(A) and (B).
6 R.C. 3920.08(C), (D), and (G).
7 R.C. 3920.08(E) and (F).
8 R.C. 3920.08(H) and (I) and R.C. 4112.01, not in the bill.
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2. “Health care facility” means any facility, except a health care practitioner’s office, that
provides preventive, diagnostic, therapeutic, acute convalescent, rehabilitation, mental
health, mental retardation, intermediate care, or skilled nursing services.9
The bill requires the Ohio Health Care Board and the Technical and Medical Advisory
Board to assess the number of primary and specialty providers needed to supply adequate health
care services to all participants in the Ohio Health Care Plan and to develop a plan to meet that
need. The Ohio Health Care Board must develop incentives for providers designed to increase
resident’s access to health care services in unserved or underserved areas of Ohio. Additionally,
the Ohio Health Care Board annually must evaluate residents’ access to trauma care and establish
measures to ensure that participants have equitable access to trauma care and specialized
medical procedures and technologies.
The Ohio Health Care Board, with the advice of the Technical and Medical Advisory Board
and the Ohio Health Care Agency’s administrator of quality assurance (see “The
administrator of quality insurance,” below), must define performance criteria and goals
for the Ohio Health Care Plan and report to the General Assembly at least annually on the Plan’s
performance. The Board also must establish a system to monitor the quality of health care and
patient and provider satisfaction with that care, and a system to devise improvements to the
provision of health care services. All providers subject to the Ohio Health Care Plan must provide
data, upon request, to the Board, when the data is needed by the Board to devise methods to
maintain and improve the provision of health care services.
The Ohio Health Care Board, with the advice of the Technical and Medical Advisory Board,
mu