Advocates, Lawmakers Seek To Change Medicaid Law

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Last year, as the Ohio General Assembly finished a contentious budget-setting session, it changed the payment process for some services and equipment covered under Medicaid. The intent was to achieve savings by making bundled payments to nursing homes and making them the delivery agent for treatments like dialysis and respiratory therapy, wheelchairs, transportation and pharmaceuticals, rather than making individual payments directly to equipment dealers and service providers. It also allows the state to draw an additional 50 million dollars in federal medicaid funds. But Democratic State Representative Kenny Yuko says for providers the change has been a disaster.

Yuko: "Great companies in the state of Ohio that have contributed to this wonderful state of ours for 30, 40, 50 years and beyond are now feeling the impact of it. They're not getting paid for their services rendered, and as a result are either forced to either close their doors or lay off valuable employees."

And, Yuko says, patients are getting lower quality care and poorly maintained equipment, and no longer have the ability to make medical choices - that's now in the hands of nursing home personnel. These consequences were unintended, he says; the amendment was supposed to be a cost saver, but after a year, he says, it's been a lose-lose proposition all around.

Yuko: "The state hasn't done well, the nursing home industry has not done well, all those who provide these services have not done well, and of course the patients themselves have not done well well."

Yuko's bill would un-bundle the medicaid funding, essentially returning to the previous method of reimbursing service and equipment providers directly - without, he says, adding to the budget.

But it might be a tough sell to State Senator Tom Niehaus, who supported the current bundling arrangement and who, so far, has no regrets. He says his primary concern is whether patients are being served well, and while he has heard a few complaints, no one has been able to demonstrate that the system isn't working.

Niehaus: "They can demonstrates that it's different. They can demonstrate, for instance, that they're not selling as many wheel chairs. They can demonstrate that ambulance companies may be laying off individuals. But no one's been able to demonstrate that the individuals are not getting the services that they're entitled to."

Meanwhile, the The Ohio Academy of Nursing Homes, an industry lobbying group, has come out against the measure. In a written statement, it says nursing holmes are successfully delivering the services, and altering the system would create new and unnecessary complications.

Bill Rice, 90.3.


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