New House Medicaid Bill Restricts Family Providers; Witnesses Fear Care Loss

People living with disabilities or caring for those individuals told a House committee Wednesday they fear their already tenuous home care arrangements will get worse with proposals under consideration to address waste, fraud and abuse in Medicaid.

The House Medicaid Committee heard from numerous witnesses Wednesday on HB795 (Williams) after adopting a second substitute version of the legislation, which among other provisions would bar family members from being paid through Medicaid waivers to provide personal care services to relatives.

Over the objection of Democratic members, the committee accepted sub bill 3280-2.

According to the Legislative Service Commission comparison document, the substitute version adds language to prohibit a spouse, parent, grandparent or great-grandparent, grandchild, sibling, aunt, uncle, niece, nephew or step-relation of a person enrolled in a waiver from receiving Medicaid payment for providing personal care services covered under the waiver.

The sub bill also established prior authorization requirements for personal care in waivers under the Ohio Department of Medicaid (ODM) and Ohio Department of Aging (ODA), but exempts personal care services for waivers under the Ohio Department of Developmental Disabilities (DODD).

The sub bill also addresses subpoena authority for the attorney general, adds criteria for the prior sub bill’s whistleblower awards, empowers managed care organizations to take fraud mitigation measures in certain circumstances, adds numerous sections related to hospice providers, and removes language related to publicly funded child care, among other provisions.

After adoption of the substitute bill, the committee spent more than two hours hearing from opponent witnesses, most of them discussing how Medicaid waiver services are essential to their independence and arguing that the loss of family caregivers could cause a strained system to collapse. Chair Jennifer Gross (R-West Chester) initially set a 6:30 p.m. stop time for the hearing but ultimately kept testimony going until all in-person witnesses remaining could speak.

Witnesses said that while committee members are talking about fighting fraud, they fear collateral damage. Some also argued that the rapid movement on Medicaid anti-fraud efforts appears part of a coordinated, political messaging campaign based on news reporting they described as dubious.

“We are getting caught in the blender with the people that you’re talking about. You may not be trying to blend us, but you are,” said Amanda Lynch, the parent and paid provider of a 24-year-old adult child with multiple disabilities, including deaf-blindness.

“If some YouTuber says there’s embezzlement at the power company, you don’t cut off the grid for six months,” said Tim McCabe, testifying in support of a friend with cerebral palsy who depends on waiver services for care.

“All of this, first of all, is very, very frightening to me,” said Jennifer Kucera, a disability advocate who receives waiver services and is chair of the Ohio Olmstead Task Force. “Disability is one of those groups that you can enter at any time of your life, and if you live long enough, the chances kind of go up that you might acquire some kind of disability.’

Rep. Josh Williams (R-Oregon), sponsor of HB795, pointed out some elements of the bill specifically exempt waivers under DODD and said further amendments are under discussion about excluding particular conditions as well. But he noted Lynch’s testimony objected to electronic visit verification (EVV) requirements in the bill and pointed out that EVV had been mandatory in the past before later becoming optional. Rep. Brian Stewart (R-Ashville) later noted that state employees must regularly clock in and out while law enforcement officers wear bodycams and travel in GPS-tracked cruisers.

“What is wrong with [tracking] in the context of the largest expenditure we have in the state of Ohio,” Stewart said of EVV requirements in Medicaid

Lynch said she’s been dealing with EVV for almost 10 years, but the system has not improved and can be an impediment to care. During her testimony, she asked legislators to consider whether she would be required to pause for a facial recognition sign-in on the EVV system if her daughter wakes screaming in the middle of the night and needs care to prevent her from aspirating.

Kucera expressed similar concerns about the functionality of the EVV system and urged lawmakers to keep continuity-of-care concerns in mind.

Matt O’Nesti, who receives DODD waiver services, said proposed EVV requirements would have disrupted his ability to go to college. “I lived in a dorm at Kent State University and almost all of my caregivers were students who also lived on campus. Because of this, there were many instances where I would be in class, and my caregivers would change shifts out in the hall. The way these proposed rules are written to enforce strict clock-ins and outs at the home along with coinciding GPS tracking, would have given us zero flexibility and created a set of circumstances where even if my dorm was established as a temporary residence for the EVV, my care staff would have had to leave me in another building for upwards to an hour while they satisfied these new rules for clocking in. This defeats the purpose of always having someone around in case I need to use the restroom or leaves me stranded if class lets out early. This rule change directly impacts the independence and mobility of those on a waiver along with continuing an unfortunate tradition of low expectations for an entire community,” he said.

Justin Martin, who receives waiver services, said only in a few of his 30 years of life has he been able to line up enough caregivers so that he could dress, shower, eat when he wants, get to work and see friends every day of the week. Martin still lives with his parents, and with a caregiver shortage pushing many people with disabilities to rely on family caregivers, he expressed a sentiment repeated by others throughout the hearing – those family members won’t always be around to provide care.

Kucera also said attempting to make exceptions for specific segments of the systems, as Williams described with DODD-administered waivers, won’t work, because many people with disabilities are on the Medicaid and ODA waivers.

Multiple committee members were fighting back tears during the testimony of Emily Lark, full-time family caregiver of Annika, a 7-year-old with disabilities and medical conditions requiring extensive supplies, equipment and devices.

“I take my job very seriously. We’ve got to address fraud issues in this state, but what you all have said will be taken seriously. And I am going to make sure that we get it correct,” said Rep. Ron Ferguson (R-Wintersville), pausing to collect himself multiple times. “I will just tell you that when people come in and testify, we have some of the same people that come in, are paid to be here, and those that are not paid to be here make 100 times the impact, at least on me.”

“I’m sickened that you had to come here today, that all of our folks with disabilities had to come here today … and justify your personhood. So, I apologize on behalf of the General Assembly that you had to do this today,” said Rep. Crystal Lett (D-Dublin), herself the parent of a child in need of waiver services.

Rep. Derrick Hall (D-Akron) in multiple instances said lawmakers appeared to be rushing toward an artificial deadline of next week, the expected beginning of the General Assembly’s summer break. He asked witnesses how much time they thought it should take to address the issues in question.

“I hope that we would take six months,” said Jen Powers Alge, director of policy and civil rights for the Arc of Ohio and parent of children with disabilities.

Gross closed the meeting by telling the witnesses their message was received.

“We did hear you, and I know there will be some good changes that you will be happy with, I’m sure,” Gross said.

Meanwhile, Senate President Rob McColley (R-Napoleon) addressed the prospect of Senate action on anti-fraud measures after the day’s session.

McColley (R-Napoleon) told reporters that if they can come to an agreement with the House to address Medicaid issues before the summer recess, “I would love to do that.”

He said he has spoken with third parties involved with the Medicaid system who have a vested interest in making sure that Medicaid is not paying fraudulent claims and have told him that there is fraud in the system.

“These groups are speaking up now because they’re frustrated that their calls, in many cases, have gone unheeded by the Department of Medicaid. They’re frustrated in many cases that they don’t feel like the Department of Medicaid has moved fast enough on a lot of these things, and they’re willing to speak up and participate with the Legislature now to see if there are things we can do,” he said.