COLUMBUS — Some independent home-health aides have experienced a delay in getting paid under an Ohio plan to coordinate care for the state’s sickest and most expensive residents, though the state says certain providers have had issues or made mistakes in submitting claims.
The workers perform health-care services for Ohioans enrolled in both Medicaid and Medicare.
The two government programs operate fairly independently of each other, and the project seeks to streamline how health care is delivered to more than 100,000 so-called “dual eligible” individuals.
The federal Medicare program serves the elderly and disabled. Medicaid provides coverage for the poor through state and federal funding.
Independent workers and home-health agencies previously submitted claims to the state government, sometimes through a billing agent.
The government generally processed the claims 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 are paid $9 or $10 an hour.
Emmanuel Swaray, director of nursing at Better World Health Care, 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.”
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 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,” Mr. 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 to result from problems and mistakes in the way providers submit claims.