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OCVIC’s State Fiscal Year 2016 and 2017 MyCare Budget Proposal

Nine months into the MyCare Ohio demonstration, a large number of enrollees still do not know where to go with questions or complaints about their care. Ohio Consumer Voice for Integrated Care (OCVIC) knows from anecdotal accounts that the Office of the State Long Term Care Ombudsman is not receiving complaints from MyCare members. The Ombudsman’s role is to investigate complaints, work toward complaint resolution, and report data to the Centers for Medicare and Medicaid Services, but many MyCare enrollees are not aware of this. In addition, Ohio’s Aging and Disability Resource Networks are overwhelmed by calls and requests for assistance related to the implementation of MyCare.  

As we move forward with the MyCare demonstration, there needs to be more focus on person-centered care. To achieve person-centered care, OCVIC feels the success of MyCare would be greatly enhanced by additional appropriations for two MyCare support systems – the Ombudsman Office (which will ensure members are not losing their services to stay in their setting of choice) and the Aging and Disability Resource Networks (which will provide information to members to help them make an informed choice). To enhance success, OCVIC is proposing for Fiscal Year 2016 and 2017 the following:

Ombudsman:

  • OCVIC believes a crucial component of MyCare is the Office of the State Long Term Care Ombudsman, which has been designated as the place where MyCare members and families can go for help if they have concerns about their care.
  • Due to funding and staffing constraints, the Ombudsman role in MyCare has been limited to responding to complaints – complaints they don’t necessarily receive, as enrollees are unaware of their existence.
  • OCVIC recommends that an additional one million dollars be appropriated to fund a dedicated MyCare Ombudsman in each of the MyCare regions and to allow each region to advertise and conduct outreach on the availability of the Ombudsman and perform routine monitoring of MyCare quality of care.

Aging and Disability Resource Networks:

  • OCVIC supports the Office of Health Transformation in working to reduce the number of individuals that receive care in institutions and allow them to get their long-term services and supports (LTSS) in their own homes and communities. The Aging and Disability Resource Networks (ADRN) are a key factor in achieving that goal. These centers, created by the US Department of Health and Human Services Administration for Community Living, support Ohio’s efforts to streamline access to long-term services and supports and are uniquely designed to provide easy access to information and one-on-one counseling.
  • The implementation of MyCare has increased the number of calls and requests for information, assistance, screening, and assessments at the ADRNs.
  • ADRN partners have been key in responding to the concerns of MyCare enrollees, resulting in increased demands on Area Agencies on Aging (AAAs) and their partners who are in direct contact with the enrollees – costs which are not being reimbursed. As a result, the time it takes to return and respond to calls has increased, and the ability of the ADRN agencies to respond fully and promptly has been negatively affected.
  • In order for the ADRN system to meet the increased demands on their time, OCVIC recommends that additional funds be included in the SFY 2016/2017 state budget to be directed to the AAAs and their ADRN partners to assure that the front door works as it was designed. The amount required is currently being assessed.

OCVIC coalition members are hopeful that with these important funding additions, MyCare enrollees will have better health outcomes and Medicaid budget growth will be further constrained. We urge the Administration to make the investments necessary to allow the demonstration to succeed prior to making the decision whether to take MyCare statewide at the end of the three-year demonstration. 

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