VOICES: In-home care for Medicaid patients at a critical point in Ohio

When parents and other family members can’t secure the in-home care their loved ones need through Medicaid, they risk losing their jobs, which negatively impacts Ohio’s economy. But the economic toll says nothing about the human toll on both patients and their families.

Ohio’s Medicaid home care is at a critical juncture because as many as 5,000 Ohioans no longer have access to quality home care services. Paying nursing aides for health care at home can cost just one fourth and be more effective than institutional care. But sick and disabled Ohioans on Medicaid are going without proper care while better-funded hospitals and nursing homes employ the few available aides by paying more than those aides could make providing Medicaid-reimbursed home care. This is impacting Medicaid patients in the Greater Dayton area, where we know people can’t get the home care they need, which can result in them being hospitalized or forced to move into a nursing home.

We very much appreciate the DeWine Administration and Ohio House for acknowledging that Medicaid rates need significant increases, and we appreciate the inclusion of rate increases in the as-introduced version of the budget. We feel like we’re being heard, and that’s a step in the right direction.

But in an environment where home care providers can make $10 an hour more working for a hospital or nursing home, it is simply not enough for the governor’s budget to raise hourly wages of Medicaid in-home caregivers from about $12 to $16 an hour. Fast food workers make more than these dedicated people who provide life-sustaining in-home care that allows families to keep loved ones safe while they work.

As a result of reimbursement rates not covering the cost of providing in-home care:

  • Home care agencies have closed, can’t hire workers and many no longer accept Medicaid patients – the state’s most vulnerable residents — with the worst impact being felt in underserved and rural communities.
  • Thousands of Ohioans are on waiting lists for home care services because there are not enough providers. These individuals are getting no care, inadequate care or must use more costly emergency rooms or nursing homes.

Medicaid reimbursement rates today are essentially what they were in 2000, while costs since then have risen more than 75 percent.

In contrast, Medicare payments average around 300% higher than the rate Ohio Medicaid pays for the exact same services, while private insurance payments average around 200% more. While providers don’t expect to be paid those rates for Medicaid recipients, providers should expect the Medicaid program to be predictable and sustainable.

If we don’t act now, the problem will only get worse. Within the next two decades, the population of those 60 and older is expected to grow more than four times faster than the state’s overall population. If we want to allow the influx of older adults to age in place and help others struggling with disabilities, chronic illness or recovering from surgery, we need to ensure Medicaid reimbursements are adequate to secure in-home care.

For the Medicaid home care program to survive, we have to cover the costs of providing the care. That is why we are asking the Ohio Senate to support a rebasing Medicaid home care rate study committee so we can evaluate tying costs to reimbursements in future state budgets.

Ohio families; their aging, disabled and chronically ill loved ones; and an efficient and effective Ohio Medicaid system all depend on assuring a stable system of in-home care.

Joe Russell is the executive director of the non-profit Ohio Council for Home Care & Hospice.

About the Author