Among the items added to the budget by Senate Republicans was a proposal that would require Medicaid to essentially re-do its procurement process for the managed care plans that want to work with the state. Advocates have said if it’s not removed, it will cause major problems – and especially in the new OhioRISE program for the state’s most troubled and vulnerable kids.
The $1 billion OhioRISE program is aimed at coordinating care for kids with complex and expensive mental and behavioral health issues across several different agencies such as behavioral health and the justice system while keeping families intact during treatment.
Lisa Norris of Columbus said it could be a lifesaver for her 12-year-old daughter Hannah, a candidate for a residential treatment program that costs $15,000 a month. She had to relinquish custody of her daughter to get her that help.
“If you found out tomorrow that your child had terminal cancer and the specialist was in Cincinnati, you would never as a parent be asked to put up $80,000 to get them in the door," Norris said. "Nor would you be ever asked to turn over custody of your child who has a life-threatening condition in order for them to get help. Anyone on the planet would say that's crazy."
Norris said Hannah is athletic and funny, but has significant trauma from her first years of life before and within the foster care system. Since she isn’t an abused child, because of the way kids are triaged in the system, Hannah ended up in a homeless shelter her first night away from her family.
An amendment added to the Senate budget would require a do-over of the Medicaid procurement process, to focus on whether applicants are Ohio based, the number of jobs created or lost with the state’s awarding of a contract, other economic factors and whether the managed care organization has a record of quality services and customer satisfaction.
Loren Anthes with the Center for Community Solutions said while the Senate budget sought to exclude OhioRISE from that, he doesn’t think it’s possible.
“It would essentially mandate that the Ohio Department of Medicaid essentially rebid its contracts with managed care," Anthes said. "The challenge is that all of these different reforms are interlinked, so it would be like taking a gear out of a clock and expecting it to read the right time. It just does not work.”
Mark Butler of Whitehall near Columbus went through the custody relinquishment process with his son Andrew, now 23.
Andrew was diagnosed with autism as a toddler, but also has a severe intellectual disability, several mental illnesses and he's nonverbal. And as he became a teen, Andrew also became violent.
Mark Butler said making the call to give up his youngest son to get him residential treatment a few years ago was the hardest he ever had to make.
“I remember saying I wouldn't wish this on my worst enemy, this feeling. And I promised that I would do everything I could to make sure other parents didn't have to do that," Butler said. "And that's why for seven years now, I've been coming to this building and meeting with senators and testifying, trying to change a broken system because a system that's broken for some of us is broken for all of us."
The Butlers’ situation is more stable now – Andrew lives a few minutes away from his family and sees his parents every weekend.
But that’s not the case for Norris and her daughter Hannah.
“We can't afford to wait for Hannah especially. It literally means the difference between her life and death. Six months down the road, my child might not be alive in this system. We can't keep her safe without the funding," Norris said. "And not only is that absolutely soul crushing to stand by and feel so helpless while we have the treatment, it's right there behind the glass door. We have the treatment to be able to help her. We don't have the money.”
The re-do of the procurement process was added into the budget by Senate President Matt Huffman (R-Lima) and Sen. Teresa Gavarone (R-Bowling Green) – both from northwest Ohio.
It comes after Paramount Health Care of northwest Ohio, owned by ProMedica, said in a statement that not being included will “needlessly disrupt care coordination and support for nearly a quarter of a million Ohio adults and children who are enrolled in Medicaid. Further, the decision will result in over 600 lost jobs in Ohio and economic losses estimated at $81 million annually for the state."
Ohio Medicaid informed Paramount last week that its appeal to reconsider its application was rejected. In its letter, Ohio Medicaid wrote that Paramount only made reference to OhioRISE 17 times in its application, while the top applicant – Humana – referenced OhioRISE 94 times, and the second-place applicant, Aetna, referenced OhioRISE 91 times. The letter states in part: “Paramount does not appear to fully grasp or otherwise has decided not to embrace the vision for the future of the program.”
Paramount president Lori Johnston told the Toledo Blade a few days later when asked about OhioRISE: "It is a very unique population and we support the program and having them have their own program. But it is no longer part of what we would be responsible for. …..I guess in hindsight we should have thrown that buzzword out a few times. I don't think the number of times we used OhioRISE should be indicative of our approach and understanding of that plan. We support the program and are very committed to seeing the program is successful with that population.”
Anthes calls the re-do in the Senate budget an anti-competitive proposal, and said it’s the first time he’s heard of a desire for Medicaid to create jobs. Anthes also notes the conservative Buckeye Institute is on the same side as the Center for Community Solutions in raising questions about this proposal.
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