The home and community-based care sector for older Ohioans and others with disabilities on Medicaid was at a critical crossroads at the start of 2023. Home care agencies were grappling with financial hardships due to woefully inadequate reimbursement rates for the services they provide to Medicaid beneficiaries – primarily low-income individuals and families. Remarkably, these reimbursement rates had remained virtually unchanged since the year 2000, despite a more than 75% increase in associated costs. In many cases, home health aides were earning more in fast-food restaurants than in the care sector.
The repercussions of these low reimbursement rates were felt across the board. Home care workers were in short supply, and thousands of Ohioans were languishing on waiting lists, either receiving insufficient care or resorting to more expensive and less suitable options like emergency rooms or skilled nursing facilities. The Dayton Daily News looked at this and related issues in an op-ed by then Jospeh Russell earlier this year: “In-home for Medicaid patients at a critical point in Ohio.”
While the specifics of these rate increases are still under review by the Ohio Department of Medicaid and Governor Mike DeWine’s administration, the expected increases are set to take effect in January 2024, addressing the acute worker shortage and covering the costs of critical healthcare services. The Ohio Council for Home Care & Hospice, along with dedicated advocates and partners, tirelessly championed this increase, and we express their gratitude for being heard.
Thank you to the Ohio Department of Medicaid, the DeWine Administration, and numerous members of the Ohio General Assembly for their invaluable support in tackling the reimbursement issue.
The timing of this development is particularly significant when considering the growing number of aging patients in Ohio. The population of individuals age 60 and older is projected to increase more than four times faster than the state’s overall population.
While the reimbursement rates have been adjusted some, there is a collective hope for a more sustainable system in the future, one that doesn’t necessitate advocacy every two years. The concept of “rebasing,” a process that currently doesn’t exist in home care as it does for hospitals and skilled nursing facilities, is suggested as a more equitable way to ensure annual adjustments based on market factors.
In the rebasing process, home care reimbursement rates would be recalculated to reflect the current state of healthcare costs and economic conditions, ensuring they keep pace with the changing healthcare landscape, and thereby making it more equitable for both providers and the patients they serve.
Lastly, a heartfelt tribute is extended to the home care workers who have chosen a path that is not always met with the recognition it deserves. It’s a calling that demands profound patience, empathy, skill and prioritizing the well-being of fellow Ohioans over financial gain. As the complexities of healthcare policy continue to evolve, the commitment is clear: to ensure these essential workers are adequately compensated for the invaluable services they provide. Their compassion, particularly to some of Ohio’s most vulnerable and medically frail residents, is both remarkable and increasingly vital as Ohio’s population continues to age.
Lisa Von Lehmden is Board Chair and Transitional Lead for the Ohio Council for Home Care & Hospice.
About the Author