COLUMBUS, Ohio — Ohio’s nursing homes prevailed in the first round of state budget wrangling.
When House Republicans this week revised the state budget bill, they yanked Gov. John Kasich’s plan to move all long-term care Medicaid patients to managed care plans next year.
The budget amendment blocks such a move until 2021, which was suggested by nursing homes, assisted living facilities, area agencies on aging and other groups working with long-term care patients.
Their main concern: A pilot program that includes some of these patients has had problems and the administration hasn’t shown it would work well for all long-term patients, many of which require extensive care.
But administration officials released a report this week they say justifies moving 100,000 of the most high-need Ohioans with Medicaid coverage into managed care plans. They say delaying the program could create a $132 million budget hole and prevent many Ohioans from receiving better care.
What did the report say?
The Ohio Department of Medicaid released a three-year progress report this week for MyCare Ohio, a five-year pilot program that put 107,000 dual Medicaid and Medicare enrollees in one of five managed care plans.
Managed care plans, which coordinate several aspects of a patient’s care, have replaced the traditional fee-for-service model where providers directly billed Medicaid for 90 percent of enrollees. The plans save money by negotiating rates with physicians, hospitals and other providers, similar to private health insurance plans.
MyCare Ohio saves $2.4 million a month and has reduced nursing home stays by 4 percent, according to the report. Moving someone out of a nursing home to in-home care saved $2,800 a month, on average. The report also touts high ratings on participant surveys and national rankings.
Greg Moody, director of Kasich’s Office of Health Transformation, said managed care allows dollars to go toward services with better outcomes. He said the study shows the state shouldn’t wait years to reap similar benefits.
“Why would we delay benefits that are available to some Ohioans when we can make them available to others?” Moody said.
What are both sides saying about the report?
The report doesn’t detail how managed care has specifically helped the program’s long-term Medicaid patients, said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents nursing facilities.
Van Runkle said more than half of MyCare Ohio’s participants are living in their own homes and not receiving waivers for long-term supports and services, and the high ratings in the report don’t apply to long-term care.
Nursing home enrollment has been declining for years, and the report doesn’t compare MyCare’s nursing home stay reduction with the rest of the population.
“It sounds great, but when you really dig into it, it doesn’t say much,” Van Runkle said.
Van Runkle acknowledged billing problems have improved but said facilities continue to have them. His association plans to release its own report next week highlighting MyCare’s weaknesses.
Miranda Motter, president and CEO of the Ohio Association of Health Plans, said those problems won’t happen under Kasich’s proposal. Unlike MyCare, she said, the state will have more flexibility in designing the new program, and the participating plans would be chosen through a competitive process.
Motter said managed care plans provide another layer of accountability over Ohio’s nursing homes, which rank among the nation’s lowest in quality. Nine of the association’s 15 Ohio health plans already manage long-term care Medicaid enrollees in the 20-plus other states that use managed care plans for that population.
Currently, Medicaid rates paid to nursing homes are set in statute. Motter said many nursing homes are doing innovative, creative work and could get paid more under a managed care model.
“That is a segment of the industry that has not been brought into the value over volume space completely,” Motter said.
What do lawmakers say?
House Republicans said they hadn’t heard enough good news about the pilot program to support the administration’s proposal. The budget amendment establishes a study committee to review the plan over the next two years.
That was before the report. Kasich administration officials and managed care plans hope the new report will sway the Senate. Both chambers must agree to a final version by June 30.
But senators raised questions about how promptly nursing homes, in-home caregivers and other providers would be paid. According to the report, MyCare Ohio managed care plans paid 90 percent of claims to providers within 30 days and 99 percent within 90 days.
Sen Bill Coley, a Butler County Republican, said that’s not good enough for small, mom-and-pop providers who run their businesses on thin margins.
“That’s basically having an effect of cutting the agency’s annual revenue,” Coley said during a Thursday Senate finance subcommittee meeting. “If we have not figured those things out, we’re going to have a lot of social service agencies go under.”
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