Transition to Managed Care Proves Rough for Ohio Dual Eligibles, Reports Say

Ohio is the latest state to experience a rough transition to managed care in its Medicaid program, according to weekend reports. Delayed payments and service disruptions to fragile patients are among the complaints. Kentucky had a similar bumpy start when it changed to Medicaid managed care in 2011, and Kansas has had many problems recently.

Add Ohio to the list of states in which the transition to managed care for Medicaid clients has not gone as smoothly as advertised.

A report in Sunday’s Columbus Dispatch, located in the state capital, chronicled the tales of home health workers who went months without pay, of agencies forced to take out loans to make payroll, and of fragile patients left without caregivers due to service disruptions.

In May, Ohio switched to managed care through 5 companies to handle services for 104,000 patients who receive care through both Medicare and Medicaid—so-called “dual eligibles.” Services for many clients took effect on July 1, 2014. MyCare Ohio focused on this group, because while they only account for 14% of the Medicaid population, they account for 34% of the costs, a state spokesman told the Dispatch.

The goals of better coordination of behavioral and physical care, as well as long-term services, may be realized in the long run, but thus far it’s been tough on patients, according to consumer advocacy groups and to patients interviewed for the report. The Dispatch profiled a former engineer who now uses a wheelchair due to spinal atrophy; the patient lost her longtime health aide when the managed care vendor did not pay the worker for more than 2 months, and the aide had to leave for a job in a nursing home.

Ohio is not the first state to experience a bumpy transition to with managed care in its Medicaid program. Its neighbor, Kentucky, had a similar start when it rapidly moved to managed care in 2011 to help close a budget deficit. Kansas’ transition, dubbed KanCare, has encountered numerous problems, including billing delays that have threatened rural hospitals and losses for insurers. New Hampshire recently delayed a portion of its Medicaid managed care transition, due to concerns that patients faced interruptions of care.

While he was not the director at the onset of the transition, Kentucky Medicaid Commissioner Lawrence Kissner acknowledged in a 2013 interview with Evidence-Based Oncology, a publication of The American Journal of Managed Care, that moving 560,000 Medicaid recipients into managed care in a 6-month period in 2011 proved overwhelming for all involved. Payment delays were common at the start, as new administrative processes and codes were implemented, but things did get better, Kissner said.

It was not ideal, but Kissner highlighted why states continue to look to managed care in their Medicaid programs: the alternatives, in the wake of rising healthcare costs, are often worse. In Kentucky’s case, options included cutting reimbursements 35% or eliminating recipients from the program, 2 ideas that Kentucky officials found unacceptable.

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