OhioSB 315136th General Assembly (2025-2026)SenateWALLET

Enact the Enhanced Cybersecurity for SNAP Act

Sponsored By: Hearcel F. Craig (Democratic), Tim Schaffer (Republican)

Signed by Governor

Health and Human ServicesPublic Assistance

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Bill Overview

Analyzed Economic Effects

23 provisions identified: 4 benefits, 10 costs, 9 mixed.

Federal eligibility requirement for Ohio Medicaid

Ohio Medicaid eligibility is limited to people eligible under section 1903(v)(5) of the Social Security Act. The supplied text does not explain which groups meet that federal rule or how many people are affected.

Job protections for Medicaid fraud reporters

Employers cannot fire, demote, reassign, or otherwise punish employees for reporting Medicaid fraud in good faith. The report must be based on a reasonable belief that fraud occurred. Employees alleging retaliation can sue for reinstatement with back pay if fired, equitable relief, and reasonable attorney's fees.

Closer checks on Medicaid family caregivers

Ohio Medicaid must establish oversight of family caregivers providing home- and community-based waiver services. Checks may include audits, renewed certification, case-manager verification, and background-check monitoring. The state may limit paid hours without documented medical need. High-risk caregivers, or those who repeatedly break department rules, may have to provide care through a waiver agency instead of independently.

Faster SNAP cards with replacement limits

For households certified for SNAP based on immediate need, counties must arrange to mail benefit cards immediately after certification. Cards go to the applicant or an authorized representative and contain the benefits the household qualifies for. The state must replace cards reported lost, stolen, or damaged within two business days after notice. At four or more replacement requests in 12 months, replacements must be withheld until federal replacement-card requirements are met. This withholding cannot apply when the requester has a disability directly related to the card's loss.

Privacy limits on Medicaid visit tracking

Medicaid agencies, providers, workers, contractors, and visit-verification vendors may use location tools only to meet required visit checks. Permitted uses include confirming service start and end times, checking claims, and preventing Medicaid fraud. The tools cannot continuously track people outside Medicaid-covered services. The Department of Medicaid cannot sell or otherwise distribute electronic visit data. That data may be used only to verify Medicaid claims and reduce program fraud.

Stronger security for SNAP benefit cards

Beginning on the amendment's effective date, all newly issued Ohio SNAP cards must have chips. Existing cards must be replaced with chip cards on the state's ordinary replacement schedule. The state must add hotline options to lock or unlock lost or stolen cards. Its website must also let SNAP recipients report suspected fraudulent transactions. These changes do not increase benefits or establish repayment of stolen benefits.

Ohio creates shared health claims database

Ohio's insurance superintendent must establish a statewide health claims database within one year after the section's effective date. Payers must submit claims as federal law allows, using formats and schedules set by state rules. Health plan issuers begin submitting claims January 1, 2028. Claims information must be available to people and government entities, and subscription fees are allowed. The superintendent must set rules for privacy, access, submissions, and penalties.

Medicaid behavioral services need advance approval

Ohio Medicaid must require advance approval for all therapeutic behavioral services covered by the program. This adds an approval step before those services are provided.

Medicaid therapy recipients must join managed care

Recipients getting the cognitive behavioral therapy specified in state law must participate in Medicaid's care management system. Healthy Ohio participants generally cannot participate, except as allowed by section 5166.406 of Ohio law. For 18 months starting on the amendment's effective date, each participating plan must enroll at least 10% of all system participants.

Higher penalties for Ohio Medicaid fraud

Medicaid fraud generally carries a fifth-degree felony and a mandatory $1,000 fine, with higher penalties based on value involved. From $1,000 to under $7,500, the penalty is a fourth-degree felony and $5,000 fine. From $7,500 to under $75,000, it is a third-degree felony and $25,000 fine. From $75,000 to under $150,000, it is a third-degree felony and $75,000 fine, with prison presumed. From $150,000 to under $750,000, it is a second-degree felony and $150,000 fine, with prison presumed. At $750,000 or more, it is a first-degree felony and $150,000 fine, with prison presumed. Specified Medicaid fraud also counts as corrupt activity when value exceeds $1,000, including combined listed violations, and at least two related, nonisolated incidents involve the same enterprise.

Ohio state workers must report fraud

Ohio state officials and employees must report alleged fraud, theft in office, or misuse of public money involving state personnel. Reports go through the state auditor's fraud-reporting system. Auditor staff may report these matters to the inspector general, and either office may refer reports to the other.

Tighter enrollment rules for Medicaid providers

Ohio may deny enrollment or renewal when an applicant owns, or lives with an owner of, a suspended or terminated provider. Provider agreements must be suspended after one year without payment claims submitted to the department. Ohio must mirror applicable temporary federal enrollment bans and deny all affected pending applications, including earlier filings. New applicants sharing an address or phone number with a current provider must be investigated, with further action when warranted. When legally allowed, Medicaid must share enrollment denials, renewal refusals, suspensions, and terminations with state health care regulators.

Medicaid must check other insurance first

Before paying fee-for-service or managed-care claims, Ohio Medicaid must electronically check for other primary insurance. The checks must use automated analysis and insurance discovery tools. Medicaid and its health plans cannot pay claims that have not been checked. Claims with another primary insurer must go to that insurer first, consistent with Medicaid's payer-of-last-resort rules.

New screening rules for Medicaid providers

Specified Ohio Medicaid providers and facilities must submit license, certification, insurance, ownership eligibility, and other required credentials every 24 months. Federal law or the Medicaid director can require shorter intervals. Enrollment and renewal applicants must disclose each owner with at least a 5% direct or indirect stake. Ohio Medicaid must check those owners for federal exclusions, other-state Medicaid sanctions, and fraud convictions, and arrange confidential sharing with Medicaid managed care plans for parallel checks. Ohio Medicaid and the attorney general must create a fraud-penalty form that applicants must sign and return before entering an agreement.

Stricter checks for Medicaid home-care providers

Ohio Medicaid must review individual home and community-based services providers in person or inspect provider sites before initial enrollment. It must repeat these checks every three years. It must deny enrollment or renewal, or suspend or end agreements, for providers sharing their main address with more than six other active providers of these services. The same actions apply when a provider shares an address with another such provider in less than 1,000 square feet. Ohio Medicaid must also refer addresses serving as the main business location for more than six such providers to the state auditor.

Extra Medicaid personal care needs approval

Personal care beyond the amount or scope in a recipient's written care or service plan requires Medicaid approval. Providers or waiver agencies must submit a signed, dated request with proof of medical need. Decisions are due within 10 business days after all needed information arrives, or within 48 hours for urgent requests. Recipients get written notice and can appeal denials. This requirement excludes personal care under Medicaid waivers run by the Ohio Department of Developmental Disabilities.

Medicaid rides get GPS payment checks

Ohio must establish GPS verification for Medicaid nonemergency rides, recording pickup, travel, drop-off, timestamps, routes, and distance. From the section's effective date, standards and a plan are due within six months, a pilot within 12, and provider use within 18. After full implementation, payment requires all necessary data; the state must pay claims with required records and no unresolved discrepancies. Providers may request documented exceptions for equipment or network failures, emergencies, or recipient-safety concerns. The state must provide training, technical support, secure data handling, and continuity-of-care protections; unrelated surveillance or enforcement is barred. Recipients cannot be denied medically necessary services solely because a provider fails to use the system. Within five years, ride data must be matched against service claims and active destination-provider agreements, allowing for documented cancellations, rescheduling, emergencies, delayed billing, and administrative errors.

Ohio investigators gain stronger subpoena powers

Ohio's attorney general may subpoena witnesses and records and administer oaths in qualifying Medicaid and care-facility investigations. Investigations may follow an authorized request or the attorney general's awareness of criminal or improper activity. Subpoena recipients may seek more time, changes, or cancellation for good cause; noncompliance can bring court enforcement and sanctions. The state auditor may subpoena records, electronic information, and testimony relevant to authorized audits, investigations, and reviews. At the auditor's request, the attorney general must seek court enforcement.

Medicaid claim checks require human review

Ohio Medicaid must flag and investigate monthly provider claims rising more than 100% without a matching increase in recipients served. Suspicious claims growth in a provider's first 60 days requires a temporary payment suspension and investigation. Automated tools must flag repeated exception requests, unusual ride activity, and mismatches between location data and claims. The state must audit verification data, may suspend agreements for noncompliance, and must refer credible fraud allegations to the attorney general. Audits confirming impossible claims require recovery of all provider overpayments, not repayment by recipients. For covered Medicaid decisions, a department employee must check automated findings and confirm they are correct before the state acts.

Medicaid home care payments need verification

Medicaid claims subject to electronic visit checks require validated records before payment. Providers must clock in and out at the service location and send service times and duration, including under self-directed care. In-home care requires GPS checks, except when a family caregiver lives with the recipient. High-risk in-home providers must also use approved identity checks, such as fingerprints, face or voice recognition, or a secure PIN. Risk signs include repeated check-in mismatches, impossible travel, hospital-stay overlaps, and unusual billing. Before denying, suspending, delaying, or recovering payment for unsupported records, the state must give providers notice, training, technical help, and compliance education.

Medicaid plans gain payment review powers

Medicaid health plans must report credible evidence of fraud, waste, abuse, or materially inconsistent billing to the department. The department must promptly refer potential fraud to the attorney general. Plans may review claims before payment with department approval; reviews may continue beyond six months without renewal. Payment suspensions require prior notice and approval from the department or attorney general. Providers get written notice, access to the plan's grievance process, and an appeal to the department. Plans must document fraud indicators and coordinate investigations, but may act before coordination is complete to prevent continued improper payments.

Medicaid provider suspensions include review rights

Qualifying fraud allegations under investigation or disqualifying indictments require suspension of provider agreements and Medicaid payments, even for earlier services. Providers or applicable owners can submit written proof they did not approve the conduct, or show good cause against suspension. Otherwise, suspension continues until the required investigations, proceedings, payment obligations, and related civil-action requirements are resolved. Evidence-backed credible fraud referrals from the attorney general or state auditor require payment suspension and review before payment, subject to federal exceptions. Providers or applicable owners get a hearing and independent administrative review; suspension continues during that review. When removing a high-risk provider would harm access, the director may instead use closer billing checks and corrective plans, with removal for violations.

Faster Medicaid provider renewals, payment risks

Ohio Medicaid provider agreements expire within three years, down from five; the Medicaid director can set an earlier expiration. Medicaid must refuse renewal when a complete application is not filed on time and in the required manner. Providers that meet those filing requirements can keep operating after expiration until the renewal decision takes effect. If Medicaid denies that renewal, it cannot pay for items or services furnished from expiration until a new agreement takes effect.

Sponsors & Cosponsors

Cosponsors

Andrew O. Brenner
Republican • Senate
Casey Weinstein
Democratic • Senate
Kyle Koehler
Republican • Senate
Mark Romanchuk
Republican • Senate
Nickie J. Antonio
Democratic • Senate
William P. DeMora
Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 195 • No: 10

House vote • 6/10/2026

Finance: Reported

Yes: 31 • No: 0

Senate vote • 6/10/2026

Concurred in House amendments

Yes: 33 • No: 0