STATE NEWS (OH)- Ohio Home Care Agencies to Seek Boost in Medicaid Reimbursement Rates in Biennial State Budget

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[MM Curator Summary]: Home care agencies in Ohio are claiming they lose about $800 every time they start helping a Medicaid member.



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Rates still at Y2K levels; Home care for older and disabled Ohioans in crisis

COLUMBUS, Ohio–(BUSINESS WIRE)–Ohio’s outdated Medicaid reimbursement model for home-based care has reached a crisis point, collapsing as reimbursement rates no longer cover the cost of providing care and preventing agencies from paying a competitive wage for the important work caregivers perform.

“We lose about $800 per patient every time we admit a Medicaid patient. Over a two-year period, we lost hundreds of thousands of dollars providing care for Medicaid patients”

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As such, the Ohio Council for Home Care and Hospice today announced that the association would be seeking long overdue and critically needed Medicaid rate increases to address the severe worker shortage and cover the cost of these critical health services.

While receiving health care at home is less costly and can be more effective than institutional care, state residents on Medicaid are increasingly added to waiting lists and go without proper care as the industry experiences an exodus of workers. As a result:

  • Home health agencies have closed, can’t hire workers and many no longer accept Medicaid patients – the state’s most vulnerable residents, with the worst impact being felt in underserved and rural communities.
  • Thousands of Ohioans are on waiting lists for home care services because there are not enough providers. These individuals are getting no care, inadequate care or use more costly emergency rooms or nursing homes, where they pay a further price in lost quality of life, independence, social interaction and well-being.

“This issue isn’t going away,” said Joe Russell, Executive Director of the Ohio Council for Home Care and Hospice (OCHCH). “Within the next two decades, the population of those 60 and older is expected to grow more than four times faster than the state’s overall population. If we want to care for the influx of older adults to allow them to age in place, and to help others who are struggling with disabilities, chronic illness or recovering from surgery, we need to address the worker shortage and cover the costs of these services.”

Lisa Von Lehmden-Zidek, Cleveland-based chair of the OCHCH board, said Medicaid reimbursement rates today are essentially the same as they were in 2000, a time period during which inflation rose more than 75 percent. For context, one agency could not take 1,693 Medicaid referrals in a single month last year due to staffing difficulties.

“The cost of home care greatly exceeds what Medicaid covers, and it makes no sense because receiving home care is significantly less costly than institutional care. If this continues, home care will be untenable and the costs for all Ohioans will increase with institutional care and more hospitalizations,” she said.

The statistics are alarming. Almost 144,000 Ohioans on Medicaid were enrolled in a home or community-based program as of August 2022, with thousands more on waiting lists. Older Ohioans are waiting from months to two years for supportive personal care services so they can live independently in their communities.

Greg Davis, a founder and co-owner of Patriot at Home, one of the largest providers of skilled home care in the Youngstown market, said at his agency, Medicare is subsidizing Medicaid. “We lose about $800 per patient every time we admit a Medicaid patient. Over a two-year period, we lost hundreds of thousands of dollars providing care for Medicaid patients,” he said.

Russell said the problem can be addressed in the State’s biennial budget.

“We should value the health and safety of Ohio’s most vulnerable in a way that’s on par with Medicare and private pay. Ohio Medicare payments can be more than 300% what Ohio Medicaid pays for the exact same service. Our goal is for state Medicaid reimbursements to cover the actual costs for care,” he said.

Advocates are seeking reasonable increases to achieve average market wages for the profession to both increase the wages and help cover overhead costs. The chart above reflects both wages and overhead, but the rate increases would allow agencies to pay RNs the market wage of $35 per hour (currently $22.20/hour) and pay aides the market rate of $20 per hour (currently only $10.10/hour).

About the Ohio Council of Home Care and Hospice

OCHCH represents over 600 home care and hospice and palliative care agencies from across the state of Ohio. Our members care for medically fragile children; those recovering at home from surgeries, and mental health and addiction treatment; older Ohioans who wish to age in place and many more.