Since the recent publication of an article I wrote, regarding Ohio Governor John Kasich's proposal to phase out Independent Providers, I have received a flood of emails. These emails are from Caregivers (IP's), people with disabilities, and concerned family members. All of them describe in horrific detail, how the Governor's proposal threatens their sense of safety and peace of mind.
With these folk's permission, I'm going to boost their signal and publish their stories in this series entitled "Ohio Wages War Against Disabled Citizens and Their Caregivers." Please read what these people have to say, share their stories, and get involved!
Jane Hash aka The Gimp Avenger!
Jane Hash aka The Gimp Avenger!
My name is Maria Matzik and I am 44 years old. I am a participant of the MyCare Ohio Dual Eligible demonstration program and I am enrolled in Molina's Managed Care Plan. I have used the Independent Provider Type since 1999. I was one of the individuals who advocated for this option back in the mid 90s after going to Washington DC and speaking with many senators and representatives. This was a result of Ohio’s Job and Family Services threatened to throw me in a nursing home on the day of my graduation because the State did not offer the coverage that I needed to “assure my health and safety”.
I have Spinal Muscular Atrophy Type II, have a tracheostomy, depend on a ventilator for breathing, and operate a motorized reclining wheelchair. I have a job as a HOME Choice Transition Coordinator and a Team Supervisor. I own my home and have a vehicle that I rely on my Independent Providers to drive. I have no family in Ohio.
I had just completed a 4 year college degree at Wright State University in 1995 where I juggled a full class schedule, student attendants (who were non-licensed individuals and were phenomenal) and agency nurses (the agencies were my nightmare). I was looking forward to graduation and beginning a new life here (I am from Pennsylvania and came here for school). Ohio decided that since I did not have 2 hours a day covered that I was not safe and the best place for me, if I decided to stay and not return to Pennsylvania, was a nursing home.
One agency, so I thought, was my savior. This agency agreed to cover me and “eat” the 2 hours. I later found out that 2 nurses working for me through this agency agreed to take a significant pay cut and that is why the agency agreed to “save me”. Other than a few nurses who left the agency after I did and become IPs and worked for me directly, the agency coverage was horrible and the so called “licensed professionals” were incompetent and anything but professional.
I had an agency nurse who could not get the concept that when you removed my ventilator tube from my tracheostomy to suction me that you had to put the tube back on after so that I could breath. Thankfully I was at work so a co-worker / informal assistant helped. The nurse was not concerned at all. When I reported this to the agency and REQUESTED that nothing be done until a new nurse was trained and showed reliability they ignored that and pulled her for my “safey”. Sounds like the right thing to do right? They left me uncovered and reminded me that I should have a back-up plan, they put her on another case with a “child” on a ventilator and my IPs covered as much as they could without pay because they knew that it would be a nightmare to get extra hours approved because the Case Managers don’t do their jobs. Just one of millions of stories.
So, when throwing around the term “Medicaid Fraud” maybe someone could take a look at how many cases the provider actually worked, but the Case Manager did not authorize the hours in writing. IPs are the ONLY providers who will NOT leave us uncovered. Agencies WILL ONLY do what they are being paid for. And the State crucifies the IPs for “ASSURING” our health and safety. Ironic or idiotic?!
That said, information gathered from the Attorney General’s office reflects the following data:
Office of Health Transformation states in its “Reform Home Care Payments” report that:
“From 2010-2014, 479 home care providers were criminally convicted, and Independent Providers accounted for 306 (~64 percent) of those convictions.”
This fails to acknowledge the dollar amounts associated with convictions and recovery of:
• IP Fraud: $ 5.9 million
• Agency Fraud: $ 5.9 million
• Agency Employee Fraud: $ 2.6 million
This brings the total dollar fraud committed by Home Health Agencies and/or their employees to $8.5M, 144% of IP fraud.
According to a Columbus Dispatch article Houston, Dallas, Detroit, Miami and Chicago Home Health Care has become so rife with fraud that federal officials recently issued a moratorium on any new agencies in those cities from billing the government for care, an anti-fraud tool that Congress authorized through the Affordable Care Act.
The Dispatch found that the Columbus metro area has more Medicare-certified home health-care agencies per person than any of those five fraud-plagued metro areas.
The Columbus area has not been placed under a moratorium, yet. If it is and there is no longer an IP program, what then?
Director Greg Moody states that after 2016 no one will be able to enter the Independent Provider pool. My question is: For individuals who choose the Employer of Record Option (which by the way Molina and most of the MyCare Ohio Plans has no idea what this is and how to go about implementing it) how will we be able to find providers? Are we just stuck with the same individuals who are currently IPs? What happens when they can no longer do this work – a job which they are already not compensated well enough for? What if we find other individuals, who are not "enrolled" IPs who want to work for us?
I am asking that under HB 64 there must be provisions implemented that will provide for a continually growing pool of Independent Providers, so that people who choose to ‘Self-Direct” in MyCare Ohio and other waivers can find Independent Providers. In the MyCare Ohio program individuals have a right to choose an Independent Provider. During the planning and implementation of the MyCare Ohio program we were told that Independent Providers would NOT go away!
The Office of Health Transformation’s “Prioritize Home and Community Based Services” initiative discusses in the HCBS transition plan to comply with new federal regulations:
“all HCBS settings must be integrated in and support full access to the Rebalance Long Term Services and Supports greater community; be selected by the individual from among setting options; ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint; optimize autonomy and independence in making life choices; and facilitate choice regarding services and who provides them.”
CMS, in their HCBS Fact Sheet dated January 10, 2014 present the following on Person-Centered Planning:
“This planning process, and the resulting person-centered service plan, will assist the individual in achieving personally defined outcomes in the most integrated community setting, ensure delivery of services in a manner that reflects personal preferences and choices, and contribute to the assurance of health and welfare.”
Prior to the implementation of MyCare Ohio it was difficult to find Independent Providers and at that time our Case Managers would post requests on the MyOhio HCP website. Today it is impossible because NO ONE wants to work for someone enrolled in MyCare Ohio because they know about the reimbursement issues (which are NOT better).
At this point our only option to find IPs is to go to:http://www.ohiohcp.org/myohiohcp.html and call or e-mail every provider (which I have done several times). No one in the MyCare Ohio managed care plans have been helpful. Recently, when I got desperate and thought that I would test what the Directors and Governor is sentencing us to I started e-mailing agencies. Either they will not respond when I e-mail or if they respond it's with a denial for the following reasons:
· They WILL NOT allow their providers to drive my vehicle or transport me (I work and actually have a life)
· They WILL NOT provide the training that my providers will need (It takes at least 3 weeks to a month or more for someone to learn how to move me without injury)
· They WILL NOT cover the hours that I need (My hours vary and some shifts end at 2am and some begin at 5am)
I absolutely hate agencies and that is the reason why 18 years ago I advocated with everyone else in the State for the Independent Providers. I find it ironic that they are pointing their fingers at IPs for fraud when the most publicized case in Ohio was the Makayla Norman case which had nurses from Exclusive Home Care Services.
As I previously stated I am a HOME Choice Transition Coordinator and I recently took a referral where an individual was physically and sexually abused by a Home Health AGENCY Aid. What about the issues with agencies? The State will not take responsibility for the areas that they have messed up - instead it is just easier to scrap an entire program.
I have had one nurse for 20 years now. She has been the most reliable person that I have ever had. She is an IP. All of my providers are IPs. In the past 18 years I have had 3 "No Shows - No Calls". When I was with agencies I cannot even begin to list the "No Shows", the "Call Offs" and the "No Coverage". And the restrictions that agencies put on the nurses and aids like they cannot transport us – how do we get to work?! And let’s not forget that EVERY agency informs us that they are not ultimately responsible to cover us.
The Directors and Governor have absolutely NO idea what it's like to have agencies as our provider. Director McCarthy recently stated at an Olmstead Task Force Meeting that he has personal experience with dealing with agencies – THAT’S A LIE! Until you are the person laying in that bed waiting on someone who does not show up, holding your bowels or bladder (or not being able to), calling off work and knowing this is your last call off, and having someone on the phone (who you don’t know) reminding you that you should have a back-up plan and there is nothing that they can do – “But have a good day” – you have NO IDEA what this is like! That is just 1 of millions of stories that have happened and will again.
The Department of Medicaid should hire (and I mean pay) someone who relies on care providers as there consultants. They will NEVER do that because that would validate that we might know something. The only time they bring People with Disabilities and the aging population to the table is when the Feds require “Focus Groups”. Our opinion doesn’t really matter – only their compliance with their requirements. I actually have a link that tells us what they are being paid (much more than our care providers and all of us).
I am tired of the bureaucrats cutting programs that are life and death for us. I have spent many hours in meetings with Director McCarthy regarding the MyCare Ohio Program, and other topics” I have to say that I feel betrayed over that. I truly believed that he had our backs - what a fool I am!
I have had enough of the games that everyone plays with us. I don't believe for one minute that anyone is on our side. They will tell us what they think will pacify us and then do whatever they want. The fight is on!
Maria A. Matzik