Tuesday, Jun 19, 2018
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Medicaid program faces Ohio budget axe


Suzette Sigrist depends on Medicaid-funded programs to live at home.

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As Suzette Sigrist’s damaged lungs and back worsened, the 72-year-old retiree was hospitalized five times between March and September last year.

The first time, Ms. Sigrist fell from a ladder and broke her shoulder.

Among subsequent health problems were two more falls, including one while she was in a nursing home for rehabilitation.

Ms. Sigrist, who said she can’t afford an assisted living apartment or in-home care, cried when told while she was in the hospital that she should move into a nursing home.

But Ms. Sigrist continued to rely on a Medicaid program that provides her with personal care five days a week, meals, and other assistance through the Area Office on Aging of Northwestern Ohio Inc.

She has not been hospitalized since September, a few months after qualifying for Medicaid and PASSPORT, a program that helps seniors receive care at home.

Ms. Sigrist requires oxygen around the clock. Some days she doesn’t feel well enough to stray from the program-provided hospital bed in her South Toledo apartment.

But other days she cleans and cooks, often with the help of a program caregiver or relative.

And she looks forward to wandering farther than her front porch, assisted by an oxygen-carrying scooter provided through the program.

“You work all your life, and you never know how you’re going to end up. Neither do your kids,” said Ms. Sigrist, who has two children, five grandchildren, and one great-grandchild.

She added: “It’s not saying it’s all good, but I have the help there.”

Some of the help that keeps Ms. Sigrist at home is threatened under Gov. John Kasich’s proposed changes to Medicaid, the single biggest program expense in Ohio’s annual budget.

Proposed cutbacks for PASSPORT could mean Area Office on Aging clients such as Ms. Sigrist could get three days of help instead of five.

Despite those cuts to PASSPORT, the state wants to add more users to the program in an attempt to divert people from nursing homes, where care comes at a much higher price.

Budget cuts

Cutting administrative costs by 15 percent in the budget’s first year likely would create a waiting list for people who want to enter the program.

A waiting list could cause some people to move to nursing homes, a move that would cost the state’s Medicaid program more than twice as much as the care received from PASSPORT.

Billie Johnson, president and chief executive of the Area Office on Aging of Northwestern Ohio, said the budget would eliminate $811,000 from the Office on Aging’s nearly $25 million in PASSPORT revenues and could cut at least 15 of 88 jobs.

Mrs. Johnson said care plans for northwest Ohio’s 2,100 participants would decline an estimated 8 percent in the first year of the budget and 15 percent in the second.

That means recipients would get less personal care, fewer meals, cuts in transportation, adult day center hours, or other services.

Payments to home health agencies under contract with the Office on Aging in 10 northwest Ohio counties would be trimmed 3 percent too, she said.

“This helps a lot of people stay in their homes,” Mrs. Johnson said. “We are saving the state money, and it makes no sense.”

Mr. Kasich appointed Greg Moody to the Office of Health Transformation to address Medicaid funding.

Mr. Moody said improved efficiencies among Ohio’s 12 offices on aging should mitigate some of those budget cuts.

‘More work to do’

“I think we all have more work to do, including them,” Mr. Moody said.

Ohio will spend nearly $18 billion on Medicaid this fiscal year. Initial estimates put the amount for the next two years at $40.1 billion.

Efforts to rein in expenses, though, reduced that figure to $38.7 billion.

The state’s cost-containment plan does not cut eligibility or optional services, such as dental.

There also are some additions to the Medicaid budget, such as spending $47.3 million to help physician offices coordinate care for patients who suffer chronic health conditions. The goal is to avoid health complications and subsequent hospital admissions.

But health-care providers who would be affected by the proposed Medicaid budget are assessing the potential damage to their bottom lines.

Nursing homes, which are paid more by Medicaid in Ohio than the national average, face $427 million in cuts as the state institutes a reimbursement schedule that has long been in the works. The Ohio Health Care Association said those cuts could mean 7,000 job losses statewide.

Job losses could hit hospitals, too, the largest single group that would be affected by the two-year Medicaid budget. Hospitals could lose nearly $478 million.

Mr. Moody said one major change ahead for hospitals under Medicaid is updating the system used to classify inpatient cases.

The state could save tens of millions of dollars by making payment classifications more specific and by not reimbursing hospitals for treating patients who acquired an illness or health condition while they were in the hospital, he said.

Scott Scarborough, senior vice president and executive director of the University of Toledo Medical Center, formerly the Medical College of Ohio, said Medicare and some commercial insurance plans are moving toward a system that pays for performance.

With the proposed budget cuts, UTMC will lose an estimated $800,000 in annual Medicaid payments, Mr. Scarborough said.

The hospital will have to make up those losses through cuts to some of its three biggest expenses — personnel, supplies, medications — as it draws up the budget for next fiscal year, which will need to account for other fluctuating payment factors, he said.

“This is probably one of 100 things that will go up or down,” Mr. Scarborough said of Medicaid payments.

Locally, the Area Office on Aging objects to the proposed Medicaid budget.

Tomorrow, the agency holds its annual legislative breakfast and plans to address federal, state, and local officials about proposed funding cuts.

Darren Horrigan, administrator of Nursing Resources of Maumee, also plans to be among health-care providers who attend that function.

Nursing Resources contracts with the Office on Aging to provide home health services to PASSPORT users.

Mr. Horrigan said Nursing Resources essentially has not had a payment increase for at least 10 years.

Some other providers have dropped out of PASSPORT, but Nursing Resources has so far held on despite increased overhead costs and costly electronic requirements from Medicaid, he said.

‘Ray of hope’

Many participants in the PASSPORT program don’t have local relatives, so reducing services could cause seniors harm physically and mentally, which Mr. Horrigan said was a major concern.

“You’re talking about one more day they’re not going to see someone, one more day we’re not going to catch something,” he said.

The local Office on Aging has the third-lowest cost per PASSPORT program participant.

It is possible that northwest Ohio will not be affected as much as it fears, and talks with the state continue, the agency’s Mrs. Johnson said.

The agency also is offering suggestions on where money could be saved, such as by eliminating or changing regulations on the state and federal level, she said.

“There’s a ray of hope,” Mrs. Johnson said. “We are hopeful that the administration will take a second look at the numbers … so people can stay at home as long as they possibly can.”

Weighing options

State officials are meeting with Office on Aging personnel again this week to discuss the PASSPORT budget proposal, said Mr. Moody of the Office of Health Transformation. To get a better handle on administrative costs, for example, offices on aging have been asked to show how much of their budgets is spent on case management versus overhead, he said.

Ms. Sigrist, the PASSPORT recipient who also has health-care coverage from Medicare and secondary insurance, used to work as a bank manager in collections.

She retired at 65, and her health started to decline about three years ago.

Her children and others initially were able to help Ms. Sigrist at home, but her son and daughter both work, and her needs intensified.

PASSPORT came on board last summer and an aide comes to her home 13 hours a week over five days to help the woman with pulmonary fibrosis and other ailments.

While Ms. Sigrist understands the state needs to save money, other cuts could be made — such as salaries for state officials, she said.

“They don’t have to take it out on the sick and the poor,” said Ms. Sigrist, who said she’s is not ready to live at a nursing home. “I don’t know what I’m going to do, but I’m not going to go back.”

Contact Julie M. McKinnon at: jmckinnon@theblade.com or 419-724-6087.

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