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Home-health workers go unpaid under Ohio's new managed-care plan

TNS Regional News • Aug 26, 2014 at 7:07 PM

She managed to cover rent this month, but the tab for her other living expenses — even groceries — is growing.“I put everything on the credit card that could possibly go on the credit card,” said Joanie Hoffman, an independent home-health provider. “I’m going to be backtracking for a while.”

Hoffman used to be paid weekly, but she said she hasn’t been receiving paychecks regularly since July 1. That’s when the state’s new managed-care plan for the elderly and younger disabled Ohioans — the “dual eligibles” who receive health coverage through Medicare and Medicaid — rolled out locally.

The government generally processed claims submitted by independent workers and home-health agencies in a matter of days. Now, the bills go to Aetna Better Health of Ohio or Molina Healthcare of Ohio, the two managed-care companies for central Ohio.

Turnaround has been slower so far, creating a problem for some. Many home-health workers live paycheck to paycheck. Those who work as aides through an agency often earn $9 or $10 an hour.

“We eat more than we get in food stamps,” said Tisha Moore, a Whitehall resident who works for two area companies — Better World Health Care and Central Ohio Healthcare Systems.

“The amount of money I earn is enough to make sure that we have dinner,” she said. “Our landlord is expecting a check, and I don’t have it.”

Emmanuel Swaray, the director of nursing at Better World, said the agency is struggling.

“Since the beginning of July, we haven’t been paid a dime for all the patients who switched over,” he said. “We’ve already lost seven patients because we don’t have staff who will work for free for now.”

Starr Dent of Central Ohio Healthcare Systems said she and her partner have been trying to pay their 67 employees with only 20 percent of their previous income flow. “It’s just devastation,” she said.

Ohio Medicaid spokesman Sam Rossi said the state and the insurance companies are working with providers to smooth the transition to the managed-care plan known as MyCare Ohio.

The three-year demonstration project, operating in 29 counties and covering some 100,000 people, is meeting or exceeding federal prompt-pay requirements on properly submitted claims, the Medicaid office reported last week.

“It means that 90 percent of all claims have to be paid within 30 days; and 99 percent, within 90 days,” Rossi said.

The state data provided, however, reflect payment percentages for all MyCare Ohio claims. It doesn’t separate those that were submitted by the home-health providers.

State and insurance-company representatives say snags seem largely due to problems and mistakes in the way providers submit claims.

“We are proactively calling our providers, answering their questions, educating them,” Aetna spokesman Rohan Hutchings said. “In some cases, we’ve even hand-delivered checks. That’s what we’ve been doing to get the money out the door.”

Amy Clubbs, Molina’s Ohio president, said the company’s turnaround for all types of claims averaged 6.2 days from January through June.

“We definitely expect that MyCare Ohio will get up to those times,” she said. “I’m really confident in our network right now.”

John Lepley is less certain. The Gahanna-area resident, severely injured in a diving accident at age 19, relies on a team of care providers who come to his home every day. Hoffman specializes in caring for patients with quadriplegia and has been with Lepley, now 40, since 1998.

Good, dependable providers determine “whether I can get out of bed in the morning,” Lepley said. “I have two providers that are over six weeks since they’ve been paid. It puts a lot of stress on people.”

Lepley’s mother, worried that he could lose care, even has paid some of his providers out of her own savings.

Hoffman said the MyCare Ohio program didn’t explain how processing times could affect low-wage and independent providers.

“I’m lucky that I had a little bit of extra,” she said. “It’s going to take awhile to get caught up.”


By Rita Price - The Columbus Dispatch, Ohio (MCT)

©2014 The Columbus Dispatch (Columbus, Ohio)

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