Advocates for people with disabilities who are on Medicaid were shocked, on February 2^nd, when the Kasich administration announced , as part of its proposed budget, the  phase-out of Medicaid funding for Independent Providers (IPs) of home care services. Under the proposal, no new IPs could bill for Medicaid after July 2016 and would be phased out entirely by 2019. Instead, individuals would have to hire personal caregivers exclusively through agencies.

But, while advocates were shocked, many people with disabilities who use independent providers were FRIGHTENED – that they would lose the assistants they depend on for carrying out basic activities of daily living, including dressing, bathing, eating and other personal activities.

This latest twist comes right on the heels of enrollment of Medicare/Medicaid beneficiaries into “MyCare Ohio” managed care plans, which has caused major disruptions in vital services, such as transportation and approval of services, for many enrollees. The most widespread disruption from MyCare Ohio came when large numbers of Independent Providers found themselves without pay for months at a time, due to a glitch in planning by the managed care plans and the state.

What reason did the Ohio Office of Transformation, which oversees Medicaid, give for this surprising announcement about ending IPs? According to one budget summary http://1.usa.gov/1LdvIjO:

The Executive Budget requires Ohio Medicaid to eliminate the “independent service provider” option as a strategy to improve the administrative oversight of the program, decrease programmatic fraud and abuse, and improve health outcomes for individuals.

The rationale makes sense – unless you know people who have relied on IPs for decades. Many individuals with disabilities have switched to hiring their own IPs, based on extensive personal experiences with agencies. They say that, with an agency, you don’t always know who will show up (it’s up to the agency) or if they will show up. Not only do personally selected IPs tend to be more reliable than agency aides, but many individuals report having the same IP for a decade or more. Whether to use an agency or independent provider is a matter of personal choice – a hallmark of the promise of MyCare Ohio.

According to national experts on home care policy, the Kasich administration may have another reason for phasing out IPs – a change in federal rules governing home care services for people with disabilities and older adults that requires adjustments to Ohio policy regarding IPs. When the IPs billed the state for services, the state treated the IPs as “independent contractors,” who were responsible for paying their own taxes and were not eligible for overtime. The new rule clarifies that IPs are employees of the state, adding significant expenses to the state. In response to this situation, California allows IPs to bill for up to 20 hours of overtime pay over 40 hours of work. For Ohio to do the same would require increased funding in the budget.

There’s at least one other way that consumers can retain their IPs – by participating in the consumer-directed care program, where the consumer becomes the employer or shares responsibilities with a “fiscal intermediary” – a person or organization to help with the financial and other requirements (although this may be problematic with the new rules). Consumer-directed care is a wonderful option for some beneficiaries, but it’s not a good fit for every beneficiary because of the responsibilities. Now that we’ve uncovered a genuine roadblock to continuing the present access to Independent Providers, OCVIC and other advocates are exploring potential ways to expand access to IPs to more people who prefer them. 

The Administration’s Surprise Smacked of Insensitivity

Whether or not, in the end, the administration’s proposal is justified by federal changes and other considerations, the manner in which the announcement was made – with no prior conversation with the disabilities community and advocates – inflicted unnecessary pain on consumers and advocates. These stakeholders have a long history of dialogue and collaboration with OHT, whose leaders know full well that many people with disabilities not only prefer independent providers (IPs), but rely on IPs for their daily survival. OHT has, in the past, previewed controversial proposals with stakeholders to seek input and improve the level of deliberations. The lack of advance discussion in this instance showed a surprising lack of sensitivity to the individuals involved, as well as the long relationship with the advocacy community.

We hope that OHT won’t repeat this “February Surprise” and, in the future, engages people early in decisions that may critically alter their well-being and subject them to undue harm.