Couch to Capitol: February 2026 Legislative Updates

Policy moved fast this month, and we break it down so you can protect clients and plan your next steps with confidence. From real wins on Medicare telehealth to high‑stakes proposals that could reshape LGBTQ care and counselor ethics, we connect the dots between statutes, board guidance, and day‑to‑day practice in Ohio.

We start with clarity on the Consolidated Appropriations Act that extends Medicare telehealth protections through December 31, 2027, including the in‑person visit waiver for behavioral health and broader geographic flexibility. You’ll hear concrete tips for 2028 readiness, like tagging clients who began services on or before January 30, 2026, to minimize disruption if requirements tighten. Then we track competing Ohio immigration enforcement packages—one limiting ICE access to sensitive locations and data sharing, the other banning sanctuary policies and compelling hospitals and mental health centers to admit federal agents, with possible funding penalties. We outline how HIPAA and confidentiality still apply and share steps for policy, training, and legal consultation so front desks and clinicians are prepared.

Next, we examine Ohio’s local conversion therapy bans and why House Bill 693 could undercut those protections while restricting gender‑affirming practice for minors and penalizing licenses. We anchor the conversation in the ethical consensus from ACA, APA, AAP, and AACAP that attempts to change sexual orientation or gender identity cause harm. At the federal level, we explain proposed CMS rules that target gender‑affirming medical care for minors and the active litigation timeline, including a spring hearing and interim guidance expected by June 1, 2026. Counseling and talk therapy aren’t directly restricted, but the mental health ripple effects are real—so we offer practical communication points for families and documentation tips grounded in evidence-based care.

We also update students and educators on CACREP’s revised Policy A2E, which requires in‑person, synchronous skill and disposition assessments in all accredited programs, including online, at least twice with one before practicum. Finally, we make space for clinician wellbeing, sharing tangible ways to use supervision, peer consultation, and community care to stay steady under pressure. Subscribe, share this with a colleague, and leave a review to help more Ohio counselors find these monthly briefings. Your work matters—and we’re here to keep you informed, resourced, and ready.

Resources Mentioned on the Episode:

February 2026 References & Show Notes:

https://docs.google.com/document/d/1PJShWrc-mfo5huLntyZa9lOnt0iGGw0Ox9gKIVKKiNA/edit?usp=sharing

*****

Connect with Us on Any or All Socials at our Link Tree!

• OCA Link Tree: https://linktr.ee/ohiocounseling

Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee

·Hosted by Mariah Payne

·Pre-Production & Coordination by Marisa Cargill, Victoria Frazier, Mariah Payne, and Chase Morgan-Swaney

·Editing by Marisa Cargill

Transcript

Welcome And Scope Of Updates

SPEAKER_00 0:01

Welcome to Ohio Counseling Conversations, How to Decapital, your quick connection from the counseling office to where laws meet lives. In this segment, we break down the latest legislative and judicial updates, policy changes, and advocacy efforts that impact counselors across Ohio. Whether you're licensed, in training, or just passionate about the field of counseling, we've got what you need to stay informed and empowered.

Medicare Telehealth Protections Extended

Preparing Clients For 2028 Standards

Ohio Immigration Enforcement Bills

Local Conversion Therapy Bans

SPEAKER_01 0:28

Welcome back to Couch to Capital on Ohio Counseling Conversations, where we bridge the gap between your clinical couch, Ohio State House, and beyond. I'm Mariah Payne, and each month it is our goal to bring you the most relevant legislative updates impacting counselors, clients, and the mental health profession across our state. It has been a dense month since our last episode in January, and you may be feeling that. So before we begin, I want to encourage you to give yourself permission to take deep breaths, move your body, and engage with this information at your own pace. In today's episode, I will cover information about Medicaid telehealth coverage, Ohio legislative packages on immigration enforcement, local conversion therapy bans, proposed federal trans health care rules, and changes in K CREP policy. There's a lot happening on the couch today, and it matters. Let's dive in. Let's start with some of the good news. If you were with us in November, we reported on Medicare telehealth and its reversion back to restrictive policies. This may have been the update that you've been waiting for. On February 3rd, the Consolidated Appropriation Act of fiscal year 2026 was signed into effect. This has extended Medicare telehealth protections through till December 31st, 2027. One of the most important things it does for behavioral health care providers is extend the in-person visit waiver. So, what does this mean? Through the end of 2027, clinicians are not required to have an in-person visit within six months of their initial Medicare, behavioral, or mental health telehealth service, or an annual visit thereafter. This law has also extended broader telehealth access for all Medicare providers, like home-based services and removing geographic restrictions. This applies across the board, but not just to behavioral health. Now, while 2028 is two years away, it is also worth starting to prepare now. One of the concrete steps that you can take is identify which of your current Medicare clients have begun their services on or before January 30th, 2026. According to the Center for Medicaid and Medicare Services, clients who began on or before January 30th are considered established patients and will only need one annual in-person visit to continue telehealth care if that waiver is not renewed for 2028. Clients who began their telehealth services after January 30th, 2026 may have to face a stricter standard, come the new regulations in 2028. By making a note in your records now, you might be able to reduce confusion down the road. So far in 2026, ICE has been operating under a significantly expanded mandate that focuses on rapid, large-scale arrests and deportations. On February 3rd, Ohio House Democrats announced a package of eight bills aimed at regulating ICE's enforcement activity in Ohio. These eight bills could bar immigration enforcement from accessing sensitive locations like schools or churches, require federal agents to clearly display their badge and ID, set a minimum standard for immigration detention conditions, and limit how state entities or data brokers can share personal information that could be accessed by federal immigration authorities. Relatedly, on February 8th, Ohio Republicans introduced a four-bill package related to ICE access. These four bills could effectively ban local sanctuary policies, criminalize undocumented presence in Ohio as a state felony, and, critically for us, require hospitals and mental health centers to allow federal immigration agents access to their premises for enforcement operations. Under this proposed package, providers who refuse ICE entry could face penalties, including the revocation of state grants or Medicaid funding. Neither of these packages have moved forward yet. However, it is worth continuing to monitor due to our ethical obligations to safeguard client welfare. Now is an ideal time to begin consulting your supervision network, connecting with legal analysis, and engaging in counselor advocacy. It's important to note nothing currently in the proposed or enacted legislation requires you to affirmatively disclose a client's immigration status, as confidentiality protections and HIPAA do still apply. The National Association of Social Workers Ohio division has published information on proactive tools and practices. The links to these trainings have been included in the show notes. Our next story continues the thread of state policy directly intersecting with our ethical obligations as counselors. In this section, I will be discussing LGBTQIA plus counseling and conversion therapy. Conversion therapy, sometimes called reparative therapy, refers to any practice or intervention that attempts to change a person's sexual orientation, gender identity, or gender expression. This includes talked-based approaches, aversion techniques, behavioral conditioning, and spiritual interventions when applied with the goal of altering identity. The American Psychological Association, the American Counseling Association, the American Academy of Pediatrics, and virtually every major medical and mental health organization in the country has rejected these practices as not only ineffective, but harmful. A 2019 Williams Institute study found that at least 698,000 Americans have been exposed to some form of conversion therapy in their lifetime, approximately 350,000 of them as adolescents. Conversion therapy has a history of documented harms. Further, there is no credible evidence that sexual orientation or gender identity can be changed through any form of intervention. In Ohio, we do not have a statewide ban on conversion therapy. Instead, we have recently seen a local legislative effort to protect minors from conversion therapy. As of today, about 15 Ohio municipalities have enacted local bans, including Columbus, Cleveland, Akron, Cincinnati, Toledo, Dayton, Athens, Lakewood, Kent, Lorraine, Westerville, Whitehall, Reynoldsburg, and even more. In September 2025, Cuyahoga County became the first and so far only county in Ohio to pass a countywide ban covering both minors and vulnerable adults. Unfortunately, these local protections could be challenged. On February 12th, Ohio Republicans introduced House Bill 693, named the Affirming Families First Act. House Bill 693 would redefine conversion therapy to state that interventions aimed at changing a minor's gender identity or sexual orientation are not classified as conversion therapy. This could have resounding impacts on local jurisdictions or policies that currently ban conversion therapy practices. House Bill 693 would also restrict professionals, including counselors, social workers, nurses, and doctors, from affirming a child's gender identity against a parent's wishes. There are potential consequences, including their license being revoked. Additionally, House Bill 693 could bar child welfare agencies from screening for or recording sexual orientation and gender identity information for the minors in their care. It could also bar teachers from discipline if they refuse to use a student's preferred pronouns. House Bill 693 has been recently introduced and it has not yet had its first committee hearings. If House Bill 693 passes as written, Ohio counselors could face another direct collision between state law and our professional ethical codes. The ACA's position on conversion therapy is clear. Attempting to change a client's sexual orientation or gender identity is unethical. The American Psychological Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry all affirm that conversion therapy practices cause measurable harm to LGBTQ youth. Since House Bill 693 is still in the early stages of its introduction, mental health professionals have a crucial role in providing information to their legislators, committees, and their representatives. Following this theme of LGBTQIA plus care, I will now discuss the proposed federal rules that are attempting to limit gender affirming care. In December 2025, the Centers for Medicare and Medicaid Services proposed two rules together that could federally restrict gender affirming care for youth across the U.S. The first rule would bar hospitals that accept Medicare or Medicaid from providing what the administration calls sex rejecting procedures to anyone under 18. This covers essentially every major hospital system in the country. The second rule would prohibit federal Medicaid and CHIP dollars from being used to pay for those services for any youth under 18 and 19, respectively. It's important for us to understand the scope here. Counseling and talk therapy are not directly within the scope of these proposed rules. They target medical and surgical intervention specifically, such as puberty blockers, hormones, and surgery. However, if finalized, these proposed rules will have a real and significant effect on the LGBTQIA plus individuals, their services, and potentially even their help-seeking behaviors. The mental health consequences of denied access to gender-affirming medical care are well documented. The Trevor Project, American Psychological Association, and again the American Academy of Pediatrics have all made this clear. Restricting access to evidence-based care worse mental health outcomes for trans youth. So, what's coming up next? Here's the timeline for you to watch. CMS is required to review the submitted public comments before they can finalize either of these rules. Given the expected volume of opposition from state attorney generals, medical associations, providers, and the public, this review will likely take time. There is no hard deadline for when they must finalize whether or not these rules move forward. Coalition of 19 to 20 state attorney generals have filed suit in federal court challenging both of these proposed rules, and a separate Health and Human Services Declaration that was issued alongside them. As a part of that lawsuit, three children's hospitals are under federal investigation: Seattle Children's, Children's Hospital Colorado, and Children's Minnesota. They have secured an agreement from HHS to pause punitive action until a court hearing is scheduled, likely sometime this spring. That spring hearing is going to be a crucial moment for us to monitor. Additionally, the Center for Medicaid and Medicare has indicated that it will issue interim implication guidance by June 1st, 2026, on how these rules will interact with Medicaid managed care plans. June is the next concrete milestone that we have. The bottom line is nothing changes for your client's care access today. These rules are not currently in effect. Keep a close eye on the American Counseling Association for practice guidance as the litigation and rulemaking process unfolds. Your role in providing care and trauma-informed support to trans and gender-diverse youth and families has never mattered more. Lastly, I have a quick but important update for counseling students, faculty, supervisors, and clinicians. K-Crep's board of directors met in February and amended their policy A2E. Starting July 1st, in 2026, all K-Crep accredited programs, regardless of their delivery method, including the fully online programs, must provide in-person synchronous experiences to observe and assess counseling skills and professional dispositions at a minimum of two points throughout the student's program, with one of those points occurring before practicum begins. If you are enrolled in an online counseling program, ask your program director how this will be implemented. If you are a counselor educator, your program is already likely moving on this since July is not that far away. This is mostly a quality assurance measure. It reflects K-Crep's commitment to ensuring that all counselors, regardless of how they earned their degree, are assessed in person for foundational skills. It's worth knowing and it's worth planning for. Now, before we close, I want to make room for you. If you are a helper, a counselor, an advocate, or a student right now, you are experiencing a lot. The immigration enforcement climate, threats to LGBTQ plus healthcare, Medicaid uncertainty, a rapid pace of policy change, this all carries weight. And if you hold identities that are directly targeted by these practices, that weight is not abstract. It can be cumulative, relentless, and real. Often in these moments, we recognize that self-care is a way that supports our ability to provide competent care. Supervision, peer consultation, and even your own therapeutic support can be crucial in sustaining your work. Connection and community are also important forms of care. Lean into your peer support. Get involved in spaces that reflect your values. Engage in community collaboration and community care. Now more than ever, it's important to remember that you are not alone in navigating this. Your work matters. You matter. I hope that with this episode, I have helped to bridge the gap between your clinical couch and the halls of our capital. Don't forget to subscribe for monthly updates. If you have questions, want to get involved, or have any additional information, please connect with us through our social media or through the contact information in our show notes. Our sources and our action links have all been listed here in the show notes today. I also encourage you to consider sharing this episode with a colleague. That way you can continue this conversation within your community. Take care of yourselves, and we'll see you next month on Couch to Capital.

SPEAKER_00 15:41

That's it for this edition of Couch to Capital, brought to you by the Ohio Counseling Association and Ohio Counseling Conversations. In the meantime, stay tuned, stay engaged, and keep advocating for the future of counsel in Ohio. Because what happens at the Capitol doesn't stay at the Capitol. It impacts every counseling conversation.