More changes expected next week to Medicaid anti-fraud bill

Republican lawmakers will continue to refine a measure aimed at curbing fraud in the Medicaid program through the weekend as they hurdle toward a self-imposed June 10 deadline.

And while House Medicaid Committee Chair Rep. Jennifer Gross, R-West Chester, reiterated Thursday the intent is not to harm the intellectual and developmental disabilities community, ranking member Rep. Rachel Baker, D-Cincinnati, said the bill as-is will do just that.

The proposal under review HB 795 picked up its second substitute version on Wednesday, and Gross said more changes are likely either at a Monday or Tuesday hearing ahead of what may be the final House sessions before lawmakers leave for the summer.

“I think we will be cutting things out of the bill so that we can make changes but not harm people,” she said. “I do believe we will continue to move forward, and our goal is to have a product that addresses fraud because we do have fraud in Ohio, as one witness said. Doing nothing and waiting while billions is being lost is not an option.”

The latest version includes a ban on family members being reimbursed for personal care services and other changes that drew significant opponent testimony from members of the I/DD community who urged lawmakers to slow down to fully understand the nuanced waiver system that falls under three separate state agencies.

Baker said she was disappointed by those changes, particularly the family member provision that became the primary focus of Wednesday’s hearing.

“I felt like until then, we were actually kind of moving in the same direction,” she said. “I really anticipated a nice bipartisan bill to actually provide resources to departments, to really provide some sort of targeted ability to weed out fraud and give our auditor, our AG, our Department of Medicaid the authority, tools and resources to make sure we’re catching bad actors so that more money is going to the people we heard from last night.”

Baker suggested that the current version of the bill would likely face opposition from both sides of the aisle, which was confirmed in a social media post from committee member Rep. Jason Stephens, R-Kitts Hill.

Stephens wrote that the three Republican members recently added to the committee — bill sponsor Rep. Josh Williams, R-Sylvania Twp.; Rep. Brian Stewart, R-Ashville; and Rep. Mike Dovilla, R-Berea — have “taken over the process” from the chair and called the 177-page substitute “an ambush.”

“Turns out, the details of this sub bill has provisions in it that totally blow up Medicaid in Ohio and will have the exact opposite effect of what we have been working towards,” he said. “This is the latest example of the style of leadership the Ohio House is under — do what we say or else. Believe me, I know firsthand!

“We were on a path to make major and positive reforms to Medicaid in Ohio to weed out Fraud, Waste, and Abuse; however, now with this sub bill and the way it was handled, how can we trust what we are being told by leadership?” he continued. “Simply put, we cannot. Oh, and to be clear, I’m a ‘No’ on this SubBill.”

Rep. Ron Ferguson, R-Wintersville, similarly criticized the process and leadership, saying he only received the substitute when it was made public and is still reviewing it.

As he did in committee, he expressed frustration over the elimination of the former Joint Medicaid Oversight Committee.

“It makes me very angry and now we’re in a time constraint,” he said. “The people currently in charge right now have been leading the chambers for the past five years or more, and some of these people have been around for 20 years. This has happened on their watch, not the watch of the people sitting on the Medicaid Committee.

“I’ve had personal conversations with each of the members on both sides of the aisle, and they all acknowledge there’s fraud and it’s unacceptable, and we have been given a gargantuan task to fix all the problems of people who have fallen asleep at the wheel,” he said.

Witnesses, who also saw the substitute shortly before the hearing began, painted a grim picture of how the changes would impact their day-to-day lives, with many framing it as a matter of life and death.

The emotional testimony, from both people with disabilities and their family caregivers, brought some committee members to tears, including Ferguson.

Gross said Thursday that the committee will not ignore their pleas, but at the same time, “We can’t do nothing.”

“The intent of the bill is to get to the fraud and not harming the people using the system appropriately and quite frankly, who need the system for survival,” she said. “What we’re trying to do is get to the people who are not providing services, so I think we have to look at how they get into the system.”

Baker said her best case-scenario for the next round of changes would be a removal of the family care provision and allowing for some flexibility surrounding GPS tracking and the electronic visit verification system.

Witnesses said the current EVV system already poses administrative challenges that result in delayed payments and delayed care. Under the bill, providers dealing with those challenges could be considered "high-risk." They also said the GPS component presented an invasion of privacy.

Baker is also advocating for the removal of provisions regarding the Supplemental Nutrition Assistance Program, which remains in the bill despite Gross’s preference that the bill solely focus on Medicaid fraud.

“My best-case scenario is that we take these big things out, make this bill actually be about Medicaid fraud and narrowing it down,” Baker said. “The chair keeps saying this is just phase one, so let’s make it the most focused phase one and do other stuff more thoughtfully with input from people in the field and with lived experiences.”

Baker also cautioned against passing a bill without a thorough review in hopes that the Senate fixes it later.

“We need to work as hard as we can to get it fixed now,’ she said. “We have to get it right now. It’s too important to risk.”

Gross said she believes lawmakers could find a way to continue allowing family members to provide care but said she could not yet commit to removing that provision entirely.

“I can see it coming out because we don’t have time to continue that conversation, but I can see some modifications on the front end, more stringent qualifications,” she said.

“What we can be doing in the coming days is removing things that caused consternation,” she continued. “We can’t please all people all the time, but we can pare it down so that we can make good substantive changes to prevent fraud but we don’t harm people in the process.”

Williams, the sponsor, said during the hearing that lawmakers are already discussing excluding certain developmental disability conditions from the provisions.

While the bill does now include a DD exemption on a provision prohibiting prior authorization for personal care services, it does not include such an exemption for the ban on family caregivers.

Any DD exemption, however, could still cause harm to the community, according to committee member Rep. Crystal Lett, D-Columbus, who has personal experience with the system.

She explained that a person seeking a waiver does not get to choose if they receive one under the departments of Medicaid, Developmental Disabilities or Aging. That may be determined by whether they also have a physical disability, the intensity of their needs, how their county board operates, and which system has available waivers and funding.

“So if you exclude family caregivers just in those DD waivers, we’re going to miss quite a few folks who are on other waivers like Passport,” she said. “You can’t just carve out the DD population in these waivers, because there are folks that are part of the DD community that are not on DD waivers.”

Lett said she believes it is possible to create a bill that addresses fraud, waste and abuse, but said those allegations should be confirmed before overhauling the system.

“There’s no reason why we have to have this bill done by June 10, and if we do a bill of this magnitude, it behooves us to take our time because people’s actual lives are on the line,” she said, highlighting testimony from witnesses who said they would take their own lives if they lost access to personal care services.

“I think the goal should be to slow down and be methodical and make sure we are supporting our most vulnerable members of society who deserve the utmost dignity and respect, and we’re on the fine line of not providing dignity and respect to our DD community as we rush this through,” she said.