Health Justice Policy Initiative
Week of October 20th, 2025
The health of women of color in Ohio is shaped by complex policies at federal, state, and local levels. Despite progress in maternal health coverage, federal rollbacks and structural inequities threaten gains. Health disparities reflect systemic governance issues, needing legislative action on social and economic determinants of health.
Federal Policy Shifts: The Ongoing Government Shutdown
The federal government shutdown, which began at the start of the fiscal year (October 2025), represents the most immediate threat to the health and economic stability of vulnerable women and families in Ohio.
Immediate Threat to WIC and SNAP Benefits
Federal nutritional programs are facing imminent funding shortfalls due to the lack of annual congressional appropriations:
WIC Program Instability: The WIC program, aiding low-income women, infants, and children with food and nutrition counseling, operates on a limited $150 million contingency fund. Experts warn it may deplete within one to two weeks of a shutdown, risking severe food insecurity for women of color who depend on it amid economic instability.
SNAP Funding Risk: If the government shutdown persists, federal officials have warned that funding may not be available to pay full benefits for the Supplemental Nutrition Assistance Program (SNAP) in November. Cuts to SNAP disproportionately harm families of color and contribute to economic hardship, which is a key driver of poor health outcomes.
Continuing Threat of Medicaid/SNAP Cuts
The instability introduced by the shutdown is compounded by the foundational, continuing risk of severe cuts proposed in federal reconciliation legislation, such as the "One Big Beautiful Bill Act" passed by the U.S. House in May 2025. The estimated $863 billion cut to Medicaid and $295 billion cut to SNAP over ten years would disproportionately harm communities of color and increase the uninsured rate in Ohio. This threat of long-term economic instability exacerbates the current, acute risk posed by the shutdown.
Active Ohio State Policy and Administrative Window
State administrative processes active in October 2025 represent crucial intervention points for advocates aiming to protect access to care, particularly Medicaid coverage.
Medicaid Work Requirements: The Critical Advocacy Window
The Ohio Department of Medicaid (ODM) is moving forward with plans to implement work or community engagement requirements for the Medicaid expansion population.
Request for Information (RFI): The state issued a Request for Information (RFI) for interested parties to submit feedback regarding the verification and exemption processes for the proposed work requirements.7 This administrative process is the critical first step in determining how eligibility will be verified, how exemptions (e.g., caregiving, disability) will be handled, and ultimately how many people, including thousands of women of color enrolled in expansion, will retain their health coverage.7 Advocacy efforts are urgently needed in this administrative phase to shape a verification system that minimizes bureaucratic barriers.
Ongoing Program Implementation and Legislative Priorities
HB 7 (Strong Foundations Act)
The implementation of Ohio's multi-pronged Strong Foundations Act (HB 7) to address high infant and maternal mortality rates is an ongoing, active process.
In July 2025, the Ohio Department of Health released its first quarterly report confirming ongoing WIC program improvements to support mothers and infants in the crucial first 1,000 days.
The Black/White infant mortality disparity ratio remains stable at 2.4, stressing the necessity of these ongoing structural interventions.
Active Enrollment Period
The open enrollment period for the Ohio Comprehensive Primary Care (CPC) program for 2026 is currently active, running from October 1st to October 31st, 2025.
This administrative action is essential for the structure of Ohio’s primary care system.
Pending Equity Legislation
Key legislation targeting systemic discrimination remains pending in the 136th General Assembly:
The CROWN Act (SB 73)
Introduced in February 2025
This bill, which prohibits discrimination based on natural hairstyle was referred to committee in February 2025
Still awaiting further action
The Ohio Fairness Act (SB 70)
Introduced in February 2025
This act, which would protect LGBTQ+ Ohioans from discrimination in housing and employment, was referred to committee in February 2025
It is still pending.
Nonpartisan Strategies for Action and Advocacy (Immediate Focus)
The nonpartisan actions required for women and groups in October 2025 are dominated by a response to the federal shutdown and intervention in active state administrative processes.
Action Strategy: Mitigate Shutdown Risk (WIC/SNAP)
Target Audience: Individuals/Families
Specific Action Step: Immediately monitor WIC benefits and stock up on essential non-perishable goods if financially possible, given the "one to two weeks" funding warning.
Policy Connections: Preserves nutritional security against the immediate threat of a federal government shutdown.
Action Strategy: Influence Administrative Rulemaking
Target Audience: Advocacy Groups/Organizations
Specific Action Step: Submit detailed feedback to the Ohio Department of Medicaid (ODM) RFI on verification for Medicaid work requirements.
Policy Connections: Maximize administrative burden and safeguard continuous coverage for the expansion population.
Action Strategy: Maximize Benefits (Maternal Health)
Target Audience: Individuals
Specific Action Step: Women who qualify for pregnancy-related Medicaid should ensure they utilize the 12-month postpartum extension for continuous care, which remains guaranteed under state policy.
Policy Connections: Access to critical maternal mental health screening and chronic condition management throughout the first year post-delivery.
Action Strategy: Support Legislative Equity Bills
Target Audience: Individuals/Constituents
Specific Action Step: Contact members of the relevant committees (e.g., Government Oversight) to demand hearings for the CROWN Act (SB 73) and the Ohio Fairness Act (SB 70).
Policy Connections: Advance legislation that reduces systemic discrimination, a key driver of chronic stress and poor health outcomes for women of color.
HUES Women’s Health Advocacy Institute’s Legislative Initiatives
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We support policies and laws such as the ACA and subsequent legislation (like the Inflation Reduction Act) which prohibit discriminatory practices such as gender rating and pre-existing condition exclusions, which historically harm women.
We are in favor of expanded access to comprehensive preventive services (e.g., screenings, contraception) at no cost. Medicaid Expansion, for example, ensures millions of low-income adults, disproportionately women of color, gain health insurance.
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We support policies that seek to invest in programs for food security, affordable housing, and environmental justice to address the root causes of chronic stress and poor health.
These policies benefit all communities, but disproportionately lifts health outcomes for Black, Latina, and Native women who are more likely to live in areas with environmental hazards, lower-quality housing, or face higher rates of poverty.
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We are proponents of the adoption of policies that require implicit bias training for healthcare providers, particularly those working in perinatal care.
Additionally, we support policy efforts that invest in community health workers and doula programs, often including Medicaid coverage for these non-clinical providers.
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We support policies that aim to collect better, more specific data to move beyond broad labels like "Asian American" or "Latina" and identify the precise needs of subgroups (e.g., Indian American or Arab American women).
Policy Ohio 101
To navigate the policy landscape, it is crucial to understand the key terms that shape advocacy and governance:
Women of Color (WOC)
Systemic Racism
Policy
A political term describing women from diverse ethnic/racial backgrounds (e.g., Black, Hispanic/Latina, Asian/Pacific Islander, Native/Indigenous, Arab/Middle Eastern) united by shared structural oppression at the intersection of race and gender.
A complex system of laws, policies, practices, cultural norms, and institutions that routinely cause and sustain unequal treatment and outcomes for people of color, often unconsciously.
A deliberate system of principles, plans, and courses of action adopted by a government or organization to guide decisions and achieve specific outcomes. Policy is made up of laws, regulations, executive orders, and judicial rulings.
Rules and laws enacted by the U.S. Congress, enforced by the President and Federal Agencies, which apply to all citizens and states. Federal law supersedes state law when there is a conflict.
Laws and rules enacted by the state legislature, enforced by the Governor and state agencies, which apply to residents within Ohio. These laws often interpret and implement federal policy.
Ordinances, resolutions, and rules enacted by county, city, township, or school district governing bodies. These policies govern day-to-day life and services in a specific geographic area.
The term emphasizes the shared political experience of being marginalized by overlapping systems of oppression in Ohio. The Ohio Women of Color Caucus (WOCC), for instance, uses a broad, self-identifying definition.
This is the root cause of many disparities in Ohio, such as the racial gaps in maternal health, wealth, and criminal justice outcomes.
Policies at all levels (federal, state, local) can either reinforce existing inequities or be intentionally designed to promote equity.
Who Makes Policy? (The Three Levels of Government)
Policy is made at three distinct levels, each with unique authority.
U.S. Congress (Ohio’s Senators and Representatives), Federal Agencies (e.g., Centers for Medicare & Medicaid Services - CMS). They set the funding for major safety nets like SNAP and Medicaid.
Ohio General Assembly (State Senate & House of Representatives), Governor, State Agencies (e.g., Ohio Department of Health, Ohio Civil Rights Commission). They determine the state budget, education standards, and specific civil rights protections.
County Commissioners, City/Village Councils, School Boards, Local Health Boards. They control local zoning, police budgets, public health programs, and school curricula.
Sample Letter of Support for Medicaid Doula Reimbursement
[Your Name]
[Address]
[Date]
Ohio Department of Medicaid
50 West Town Street, Suite 400
Columbus, OH 43215
Re: Support for Adequate Medicaid Doula Reimbursement Rates
Dear Director [Name],
I am writing to express my strong support for establishing adequate Medicaid reimbursement rates for doula services in Ohio. I believe appropriate doula reimbursement is essential to expanding access to this evidence-based intervention.
The Need for Doula Services
Research consistently demonstrates that continuous labor support from doulas leads to improved birth outcomes, including reduced rates of cesarean births, decreased need for pain medication, and shorter labor durations. For Black women in Ohio, who face significantly higher rates of severe maternal morbidity and pregnancy-related mortality, access to culturally concordant doula care is particularly critical.
Current Barriers
While HB 248 has established funding for community doula programs, inadequate reimbursement rates create a barrier to sustainable doula practice and limit the number of providers available to serve Medicaid beneficiaries. Many experienced doulas cannot afford to accept Medicaid clients at current rates, creating access disparities.
Our Recommendations
Establish reimbursement rates that reflect the full scope of doula services, including prenatal visits, continuous labor support, and postpartum care
Set rates comparable to those paid by private insurance to ensure equitable provider networks
Include reimbursement for administrative time, travel, and on-call availability
Create streamlined credentialing processes that recognize diverse doula training pathways
Allow for enhanced rates for doulas providing culturally and linguistically concordant care
Community Impact
[Include specific local data or stories about maternal health disparities and the need for doula services in your community]
We urge the Department to prioritize establishing reimbursement rates that will make doula care a viable and accessible option for all Medicaid beneficiaries in Ohio. We welcome the opportunity to discuss implementation strategies and would be happy to provide additional information.
Sincerely,
[Your Name and Title]
Previous Updates
Week of Sept. 15