Ohio Counseling Conversations

Couch to Capitol: July 2026 Legislative Updates

• Ohio Counseling Association

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Laws don’t feel abstract when they land on your schedule, your billing, or your client’s ability to get through the front door. We’re back with a summer policy check-in that connects Ohio legislative news, federal rulemaking, and real clinical impact for counselors across the state.

We start in Ohio, where a vetoed absentee voting bill highlights how barriers to civic participation can hit the same communities we often serve. Then we dig into a big practice-stability win: new limits on insurance clawbacks, plus the Access to Care bills that could improve network adequacy, stop retroactive prior authorization denials for behavioral health, and require private insurers to cover telehealth mental health services. We also unpack fresh data on reimbursement gaps, provider shortages across Ohio counties, and what a steep drop in ACA marketplace enrollment could mean for clients who suddenly can’t afford coverage.

From there, we zoom out to Washington. We break down the proposed Medicare Physician Fee Schedule, including the plan to extend the mental health telehealth in-person waiver, and why the numbers still matter for reimbursement. We also flag the “Do No Harm” earnings benchmark rule that could squeeze counseling programs and student loan access, even as the workforce shortage grows. Finally, we cover the status of 988’s specialized LGBTQ youth routing, what to update in safety plans right now, and the growing reach of the counseling compact for interstate telehealth.

If you want clear, counselor-focused mental health policy updates without the fluff, subscribe, share this with a colleague, and leave a review so more counselors can find it.

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Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee 
Hosted by Dr. Marisa Cargill
Pre-Production & Coordination by Dr. Marisa Cargill, Lauren Collins-Knight, Victoria Frazier, and Mariah Payne
Editing by Dr. Marisa Cargill


Welcome And What’s Moving

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Welcome to Ohio Counseling Conversations Couch to Capital, 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. Welcome back to Couch to Capital on Ohio Counseling Conversations, where we bridge the gap between your clinical couch and the halls of Ohio State House and beyond. I'm Dr. Marissa Cargill, and each month it's our goal to bring you the most relevant legislative updates impacting counselors, clients, and the mental health profession across our state. Ohio lawmakers are on summer break. The Supreme Court just wrapped its term, and Congress is arguing about whether to permanently spring the clocks forward. Meanwhile, Centers for Medicare and Medicaid Services dropped a brand new Medicare rule. HHS quietly backed off a plan that would have hit trans youth healthcare nationwide. And the 988 lifeline just marked one very complicated anniversary. It may be summer break, but that doesn't mean nothing's happening. Let's get into it. With the Ohio General Assembly out until mid-September, this episode widens the lens a little. We're covering state action from just before the break, what's moving federally right now, and a few things every counselor should have on their radar heading into fall. Let's start at home. In Ohio, we'll start with what didn't survive. On June 24th, Governor DeWine vetoed House Bill 472, which would have required Photo ID to cast an absentee ballot, including a brand new online portal for uploading ID images. In his veto message, DeWine leaned on warnings from the Ohio Association of Election Officials and AARP that the bill would burden senior citizens, people with mobility challenges, and voters with limited access to technology. And that it came with no funding to actually implement it. Why does that land on a counseling podcast?

Ohio Voting Bill Veto

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Because civic participation and a sense of agency are protective factors we talk about constantly with clients navigating depression, grief, and major life transitions. Barriers to voting hit hardest exactly where our caseloads sit. Older adults, people experiencing homelessness, clients with disabilities. That one's resolved for now, so no action needed. But it's a good one to keep in your back pocket for client conversations about civic engagement this fall. Now here's one that did survive and it's good news. On July 8th, DeWine signed Senate Bill 162 into law. This is the bill that puts a real clock on how far back a health insurer can reach to clawback payment from a provider after a claim's already been paid. If you've been following this show, you know this is the care source style clawback issue we've talked about before. Insurers retroactively demanding money back, sometimes years after a session was billed and paid. This is a direct win for practice sustainability, especially if you're a solo practitioner or a small group practice without deep reserves

New Limits On Insurance Clawbacks

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to absorb a surprise five-figure clawback. Nothing to act on here either. It's signed and done, but definitely worth knowing your rights just changed. Which brings us to three bills still very much alive. House Bills 219, 220, and 709. These are the Access to Care Trio. House Bill 219 would set network adequacy standards for Ohio insurers. That's had two hearings so far. House Bill 220 bars insurers from retroactively denying prior authorization for mental health or substance use treatment. That one's already passed in the House. And House Bill 709 would require private insurers to cover telehealth mental health services, one hearing in bipartisan sponsors on both sides of the aisle. All three are sitting on ice until the legislator's

Access To Care Bills To Watch

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back in the fall. And remember, anything that doesn't pass by the end of the year has to be reintroduced from scratch in the next General Assembly. So if you want these prioritized, now's actually a good time to reach out to your state rep before the fall crunch hits. And here's exactly why those three bills matter. A Health Policy Institute of Ohio study out July 9th found that nearly half of Ohio families said their child's mental health care was blocked because their insurance wasn't accepted. 40% pointed to the provider availability. 29% said cost. And here's a number that'll land with anyone running a practice. Ohio behavioral health clinicians are reimbursed 18% less on average than medical or surgical clinicians, which is a big structural reason so many of us stopped taking insurance in the first place. 75 of Ohio's 88 counties are now mental health shortage areas. This is the data behind every long wait list and every family that quietly disappears from care. And it's the evidence base for House Bills 219, 220, and 709. Sticking with insurance for a second, because there's a second data point that lands right alongside it. Also on July 9th, we learned Ohio had the single largest drop in ACA marketplace enrollment of any state in the country. A 32.4% drop, about 161,000 people, after the enhanced federal subsidies expired. Commercial insurance is already the harder coverage type for behavioral health access, more so than Medicaid per that same health policy institute research. So if a chunk of our clients are losing marketplace coverage altogether, expect more self-pay conversations, more sliding scale requests, and more people falling out of

Shortages, Reimbursement, And Coverage Loss

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care entirely once their subsidized plan becomes unaffordable. It is worth checking in with clients and having ongoing conversations to help them access care and inform how we can advocate for our profession and those we serve. Two more pieces of research rounded out the month. An Urban Institute survey released July 1st found 30% of Ohioans needed but didn't receive at least one type of reproductive health care in the past year, despite Ohio's 2023 constitutional amendment protecting reproductive rights. Young people, people with disabilities, and LGBTQIA plus Ohioans reported the highest unmet need. And that intersects with plenty of what shows up in session: perinatal mood disorders, family planning anxiety, the compounding stress of navigating a fragmented healthcare system. And back on June 25th,

Reproductive Care Gaps And LGBTQ Data

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a report on LGBTQ plus health outcomes in Ohio reported that gay, lesbian and bisexual Ohioans are 2.6 times more likely to report frequent mental distress than their peers, and transgender Ohioans are three and a half times more likely. Researchers pointed to stigma and gaps in provider training as two drivers. But there's a third one worth slowing down on a genuine data gap. Since early 2025, federal surveys have quietly stopped asking questions about gender identity and sexual orientation. That means the government is no longer consistently tracking how this population is actually doing, which sounds abstract, but it has real consequences. Take the data away, and you take away the evidence base for making the case that these disparities are real and worth the funding a response to, even while the disparities themselves keep showing up in every study that still manages to measure them. One researcher's phrase really stuck with us. This isn't about the population having different innate outcomes, it's death by a thousand cuts from chronic minority stress. That's squarely an ethics and competency issue under our code of ethics. Affirming culturally competent care isn't optional, and this data just makes the stakes concrete. With the Ohio legislator out until mid-September, your state rep and senator are back in the district, home at community events, holding office hours, and it may be your best shot at FaceTime with them. That makes this the ideal window to request an in-person meeting before that fall session crunch hits. A five-minute conversation in their hometown office often lands harder than any email once they're back in Columbus. Top of the list to raise as a counselor right now, Senate Bill 274 and House Bill 172, which are companion bills that would repeal Ohio revised code 5122.04. The exception that currently lets

Summer Advocacy On Minor Consent

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minors seek counseling without parental consent. Removing that exception could shut out the young people who most need somewhere safe to turn, including kids in unsafe homes or in the middle of a crisis where a parent isn't a safe first call. Two ways to act right now: you can request a meeting with your state rep and senator while they're local this summer. You can also submit written opposition testimony on Senate Bills 274 and House Bill 172 and get that on file so that it shows up when committee work resumes. That's the state picture. Let's head to our nation's capital. While state lawmakers are on break, Washington has not stopped moving. And a few of these decisions land directly on how we bill, what we can offer via telehealth, and who gets access to care. First up, brand new as of this recording, the Centers for Medicare and Medicaid Services released its proposed Medicare Physician fee schedule for 2027 on July 14th. The headline for us is genuinely good. CMS is proposing to extend the mental health telehealth in-person visit waiver all the way through December 31st, 2027. Matching the multi-year telehealth extension, Congress already passed earlier this year. That's stable welcome news if you're doing virtual sessions with Medicare beneficiaries. The catch is a proposed cut to the overall fee schedule conversion factor, since the temporary 2.5% pay bump

Medicare Telehealth Waiver Extension

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Congress gave for 2026 doesn't carry forward into next year. Public comment is open through September 14th, so if you bill Medicare, this is worth weighing in on. Next, one that hits our own training pipeline directly. Buried inside last year's House Resolution 1, the One Big Beautiful Bill Act, is a provision known as Do No Harm. As of July 1st of this year, every academic program at a school that participates in the federal direct loan program has to show that its graduates out-earn a federally set benchmark within four years of finishing the program. If a program misses that benchmark two years out of three, it loses access to federal direct loans for its students for two years. Here's why that should worry every one of us. Counseling programs, like a lot of helping

Do No Harm And Counselor Training

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profession programs, train people for essential community-based work that has never been high-paying. This isn't a knock on the field. It's the reality of how these rules are funded and reimbursed. Under this rule, a counseling program can do everything right and still get flagged as a low-earning program simply because the field itself is underpaid, which puts real pressure on programs to shrink enrollment, cut training tracks, or close altogether. And if a program loses direct loan eligibility, prospective students lose the ability to finance their education there at all. This at a moment when the country is already facing a severe shortage of mental health providers. To be clear, counselors and counselors in training absolutely deserve higher pay. But the fix for that is fair reimbursement rates and real investment in community mental health, not choking off the loan pipeline that gets people into the profession in the first place. And one more this week, and it's a genuinely contested one. So let's lay out both sides. On July 21st, House Republicans voted to attach the Save America Act, a voter ID and proof of citizenship bill for federal elections, onto the National Defense Authorization Act, the annual must-pass defense funding bill. This is the latest move in a fight that's been going on for over a year. Supporters, including President Trump and most congressional Republicans, argue it closes real gaps in the voter registration system. Pew research found the vast majority of Americans across party

Federal Voter ID Fight

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lines say they support voter ID in general. Opponents, including most congressional Democrats and voting rights groups like the Campaign Legal Center, argue the specific documentation requirements go well beyond a typical ID check, requiring a passport or birth certificate rather than a driver's license, for instance, and that more than 21 million Americans don't have easy access to those documents, with older adults, married people who've changed their name, and people of color disproportionately affected. It would also end most male voter registration and require states to run frequent list purges. Where it stands right now, it's attached to the defense bill in the House. But Senate leadership on both sides has said the election's language likely gets stripped out before the NDAA can pass there. So its ultimate fate is genuinely unresolved. Why bring this up at all on a counseling podcast? The same reason we flagged House Bill 472 veto earlier. Civic participation is a protective factor for a lot of our clients. And whichever side of this you land on, it's worth knowing the documentation and process barriers being debated since they land hardest on some of the same populations we serve, older adults, people who have experienced housing instability, and anyone without easy access to a passport or birth certificate. Next, a lighter one, but it's got real clinical relevance underneath it, and honestly, some genuine debate. The House voted 308 to 117 on July 15th to pass the Sunshine Protection Act, which would end a twice-yearly clock change and make daylight saving time permanent nationwide. It heads to the Senate next, and its fate there is genuinely uncertain. Here's why it's worth more than a passing mention. There's actually a case on both sides for this one. The argument for it is that ending the twice-yearly switch removes a documented disruption. The week after each clock change has been linked to upticks in sleep

Daylight Saving Time And Mental Health

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disturbance, mood dysregulation, and even cardiac events. So a lot of clinicians would welcome one less seasonal adjustment for clients who already struggle with routine and regulation. But, and this is the part sleep researchers keep raising, permanent daylight saving time specifically, as opposed to permanent standard time, means darker mornings through the winter months. Some sleep scientists argue that's the worst trade-off for circadian health and seasonal mood symptoms, because morning light exposure is what helps regulate our internal clock, and pushing sunrise later in the winter could actually work against the people most vulnerable to seasonal mood shifts. So it's not a clean good news story. It's a no more switching versus the specific schedule they picked may not be the one sleep science would have recommended. And now the one that needs a little more care in how we deliver it. On July 13th, after nearly 20,000 public comments and opposition, the Department of Health and Human Services confirmed it is not moving forward with a proposed rule that would have barred any hospital providing gender-affirming care for minors from participating in Medicare and Medicaid, which practically speaking is almost every hospital in the country. Advocates are calling this a reprieve, not a resolution. The administration is still pursuing a separate rule that would block Medicaid and chip funds specifically for gender-affirming care for minors, and state-level bans remain in place regardless, including Ohio's own ban, which is still pending before

HHS Gender-Affirming Care Update

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the Ohio Supreme Court. For anyone working with trans and gender-diverse youth and families, this is a live, unresolved situation, and it's worth being precise on air about exactly what changed and what didn't. We will continue to monitor how this impacts us as counselors and the communities who are also affected by these discriminatory initiatives. That covers the federal landscape. Let's close with what's happening in our own advocacy community. First, a one-year mark that matters. Quick background for anyone who needs the refresher. Since 2022, the 988 Suicide and Crisis Lifeline has offered specialized routing options for certain high-risk groups. Press 1 for veterans, Press 2 for Spanish speakers, and starting in 2022, Press 3 connected callers to counselors specifically trained to work with LGBTQ youth and young adults. That option had handled nearly 1.5 million contacts by the time it was shut down in July of last year, when the administration ended it, citing funding as a part of a broader

988 Press 3 Still Offline

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rollback of federal DEI-related programs. July 17th of this year marked exactly one year since that shutdown. Since then, Congress has stepped in, lawmakers appropriated $33.1 million specifically to restore the service, and HHS says it's working on a relaunch. But as of mid-July, a bipartisan group of House members is still publicly pressing HHS to move faster. And there's a real open question about whether the Trevor Project, the nonprofit that helped design and originally run the program, will even be part of the relaunch. So here's where that leaves us practically. The funding exists, the political will exists on both sides, but the service itself is still not operational. If you do crisis work or safety planning with LGBTQ youth clients, that distinction matters. Right now, 988 still functions as a general crisis sign for everyone, but the specialized press 3 routing to specifically train counselors is not currently available. We want to be precise on air about that. It's not back yet. In the meantime, if you're doing safety planning with LGBTQ youth clients, make sure your referral list reflects reality. 988 works as a general line right now, but for LGBTQ Plus specific trained support, the Trevor Project still runs its own 24-7 crisis line, independent of 988. That number is 1866-488-7386. Update your resource sheets accordingly until Press 3 is actually back. On a brighter note, Pennsylvania just became the 40th state to join the counseling compact. Governor Shapiro signed the legislation July 12th and 13th, and it's set to take effect in 60 days. Ohio's already a member state, so this is really about widening the map for our telehealth-based colleagues and for any of our clients who travel or relocate and want to keep working with an Ohio licensed counselor. Currently, there are six states who are live and issuing privileges for professional counselors to practice across state lines. These states include Ohio, Arizona, Georgia, Indiana, Louisiana, and Minnesota. To learn more about the counseling compact, check out the link in our show notes.

Counseling Compact Expands Again

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And finally, a couple quick housekeeping items before we go. ACA Hill Day registration closes July 31st at 1159 p.m. That is your direct line to advocate on federal issues we just covered live and in person this September with other counselors from across the nation. Counselors will meet with lawmakers in our nation's capital to address the issues that affect our profession and those who are impacted by it. There's a link to register in our show notes. And lastly, the All Ohio Counselors Conference registration is open now with its early bird pricing. So

Hill Day And Conference Deadlines

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get that locked in while the discount lasts at oca.events. That wraps up this month's episode of Couch to Capital. Make sure you're subscribed so you never miss an update. And if you have questions, feedback, or want to get involved with our advocacy efforts, be sure to drop us a line. You can text us or connect with our socials found in the show notes. 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 counseling in Ohio. Because what happens at the Capitol doesn't stay at the Capitol. It impacts every counseling conversation.