A plea for Medicaid changes

A little-noticed change in how the state pays for wheelchairs, physical therapy and other care has caused some Ohio nursing-home residents to lose services and others to fear that they could be next.

In central Ohio, some nursing-home residents have been denied care after being erroneously told that the Medicaid services were no longer covered because of cuts in the state budget.

"I used to get a complaint every once in a blue moon. Last week, I had three, and all were told that this was because of new Medicaid rules," said Susan Marshall, the ombudsman for long-term care in Franklin and several surrounding counties.

"One was for a wheelchair, one was for a walker and one was for speech therapy. It's heartbreaking, and it makes me angry. There's no excuse that these people can't get the things they need to live a decent life."

At a hearing in Columbus yesterday, nursing-home residents, service providers and an administrator from a lone institution urged state officials to reconsider a new payment system tucked into the $50.5 billion state operating budget approved in July.

The change "will drastically affect my ability to have my wheelchair maintained. It will be like losing my legs all over again. I will be even more limited than I am now," William Plott, 60, of Cleveland, testified.

Plott's multiple sclerosis was diagnosed in 1985 at age 36. Every day, the chronic disease affecting his brain and spinal cord claims a little more of his independence.

He lost his ability to walk two decades ago. Since 2001, when the disease progressed to the point that he needed help with the most personal care, he moved into a nursing home. He relies on a motor-

ized wheelchair and specialized transportation to get around.

Under the new rules, ancillary-care services -- transportation, therapy, over-the-counter medications and durable medical equipment such as wheelchairs -- are no longer billed directly to the state's Medicaid program.

Instead, nursing homes receive $3.91 per day per Medicaid patient to cover those expenses.

State Sen. Tom Niehaus, R-New Richmond, said the new billing system was a way for the state to draw more federal Medicaid funds and that the $3.91 figure was based on 2008 expenditures for such services divided by Medicaid beds.

"These services are not being cut. (Medicaid patients) are entitled to them," he said. "This was a way to ensure that these ancillary-care services continued."

Indeed, Julie Evers of the Ohio Department of Job and Family Services, which oversees the Medicaid program, said the services covered haven't changed.

The agency was required to hold yesterday's hearing and can recommend changes to the new rules.

Sen. Dale Miller, a Cleveland Democrat who opposed new rules, said nursing homes now have a financial incentive to provide as little service as possible.

"I'm very concerned that the new system is going to encourage nursing homes to turn away certain types of patients that aren't going to work well for them financially," he said.

Gary Bajusz, president of the Cleveland-based Integrated Medical Inc., a medical-equipment provider, said that before passage of the budget, his company would conduct 100 evaluations a month for wheelchairs. Since the budget was approved, he has not received a call.

"What happened to those consumers? Were they all miraculously healed?" he asked.

Deb Carr, administrator of Westpark Neurology & Rehabilitation Care Center in Cleveland, where Plott lives, told state officials that the funding level is insufficient to cover services required for patients with acute needs.

The center cares for 75 Medicaid residents ages 20 to 60. Under the new fee structure, the center will receive $107,000 a year to cover expenses for wheelchairs; transportation; oxygen; physical, speech and occupational therapy; and over-the-counter medications. That's $223,000 less than the $330,000 yearly expense for such services, she said.

"What will happen when the day comes -- notice that I am not saying 'if' the day comes -- that the home is not able to pay vendors for the services residents need?" she asked. "Where will these residents go?"