Independent health workers not Medicaid option in budget
COLUMBUS (AP) — Certain Ohioans with disabilities or chronic conditions who get care at home through Medicaid could see a change in who helps them bathe, get dressed and tend to their basic needs.
A proposal in Republican Gov. John Kasich’s two-year state budget would direct the state to accept billings for such Medicaid services from certified home-health care agencies, not independent health aides, nurses or other providers.
That means about 16,000 individuals who receive help from more than 13,000 independent workers would have to make other arrangements, either through a home-health agency or by applying to become the providers’ employer.
The transition would happen over four years, if approved by state lawmakers.
The move comes as the Kasich administration seeks to reduce Medicaid fraud and improve care by using home-health agencies, which officials say have more oversight.
Investigations by a unit in the state’s attorney general’s office led to the criminal convictions of 479 home health care providers between 2010 and 2014, with independent providers accounting for 306, or 64 percent, of those convictions.
But returning to agency care terrifies Jane Hash, who has a brittle bone disorder known as osteogenesis imperfect.
“That was about the worst care I ever received,” said the 40-year-old Hash, who relies on independent aides for several hours a day at her home in Kent.
She sought help from independent providers more than 10 years ago after finding agency workers unreliable and varied.
“You don’t know who’s getting you out of bed from one day to the next,” Hash said. “If they don’t come to work, I don’t get out of bed. I don’t use the restroom and I don’t eat. I’m completely dependent on them for mobility.”
Hash interviewed workers over the phone and then met them in person before deciding who would provide her care.
“It’s definitely a less stressful process than not knowing who an agency is going to send you,” Hash said.
Ohioans could keep their independent providers if they seek what’s called a consumer-directed option, administration officials said. If eligible, recipients would then become the workers’ employer and coordinate their own care.
“For folks with longstanding relationships with a particular individual, consumer-directed care is essentially what they’re doing already,” said Greg Moody, director of the governor’s Office of Health Transformation.
Still, the process and paperwork could be tricky for some recipients to navigate.
“I couldn’t make heads or tails of it,” Hash said when she looked at the option.
Those with disabilities have enough challenges in their days, Hash said. “We shouldn’t have to ask for special treatment just to have a choice in who gets us out of bed.”
Ohio would be joining many other states and the federal Medicare program by doing business with agencies only, the administration said.
Officials also emphasize that the change would not be immediate.
Starting in July 2016, Ohio Medicaid would not take claims from any new independent providers. By July 2019, the state would only accept billings submitted through agencies.
Independent workers could seek employment through an agency, though wages are often lower.
Some health care advocates have criticized Kasich’s plan as undermining consumer choice.
“Individuals want to choose the person or persons who provide that care because these people are in their homes and in their personal lives on a continuing basis,” said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio.
Moody said individuals who only have one independent provider “really have no choice” when that caregiver is unavailable to them. “And that can be a very dangerous situation.”
Moody said the state would try to encourage agencies to make consistent staff assignments.
John Stacy, a spokesman for the Ohio Council for Home Care and Hospice, said agencies try to work with their clients to make sure they find a worker who meets their needs. The organization, which represents home-care agencies across the state, supports the governor’s proposal but also questions whether the agencies will have the capacity to care for more people.
“I don’t think we really know the answer to that yet,” Stacy said.