Ohio Medicaid reform plan starts with ill children

[cougarnurse]

Guess it's already starting: http://www.dispatch.com/live/content...-children.html

State officials want to change the way they provide health care to the sickest and most expensive participants in the tax-funded Medicaid program, beginning with more than 37,000 disabled children.

Under Gov. John Kasich's budget plan, the youngsters would be enrolled in managed-care plans beginning next year.

Similar changes would come later for the mentally ill, nursing-home residents, those receiving home- and community-based services and so-called dual eligibles, the poor elderly and disabled served by both Medicaid and Medicare.

The Kasich administration hopes better coordination of care will improve health and save money on Medicaid's so-called hot spots, which eat up the biggest portion of Medicaid spending.

It's a move that could send thousands more patients into one of Ohio's seven managed-care plans - but not right away, and maybe never.

State officials say they hope to see new collaborations emerge among groups willing to coordinate and provide care at a fixed price.

"We want a point of coordination, but not necessarily managed care," said Greg Moody, director of the governor's Office of Health Transformation. "To me, it's good old-fashioned market competition. It could be managed-care companies. It could be a skilled nursing facility."

The state moved healthier populations of Medicaid recipients onto managed care several years ago.

Moody said he envisions partnerships of health providers who will work together to ensure patients receive less fragmented and more coordinated care that will focus on preventing illness and avoiding duplicative services and unnecessary hospitalizations.

For example, mental-health services could be managed by a collaborative of mental-health hospitals, community mental-health service providers and others.

"It's not easy to say who will win or lose, but who is going to work their way into a partnership," he said.

In a budget that cuts hundreds of millions of dollars to hospitals, nursing homes and other Medicaid health-care providers over the next two years, Kasich also proposes spending $87 million in start-up costs to move disabled children from a fee-for-service program into managed care. The governor is allocating another $47 million to promote health homes, a concept similar to care coordination in which a primary-care doctor or specialist works with hospitals and others to oversee a patient's care.

Moving disabled children into managed care is intended to be a short-term fix. The administration is encouraging Ohio children's hospitals and managed-care companies to develop partnerships, modeled after Partners for Kids, a local care-coordination organization working with Nationwide Children's Hospital and a network of 760 physicians.

Moody said the managed-care companies were ready to take on the financial risk of accepting a fixed fee to care for these children, but the system will create a "pathway" for the hospitals to take over if they choose.

Nick Lashutka, president of the Ohio Children's Hospital Association, said children's hospitals already are coordinating care and are eager to work with the administration to develop alternative-care organizations.

Ultimately, he said, the greatest savings may come by leaving out the middle man and allowing for direct savings between the hospitals and the state.

[cali510]

My job is funded by medicaid reimbursements for homebound permanently disabled children. Home health agencies have been cutting wages for eight years now, always saying that the medicaid reimbursement rates have been slashed. I guess this will just bring another round of cost cutting so they have another reason to cut wages. My paycheck yesterday had a letter from the boss stating there would be no pay raises because medicaid cut payouts. I wonder how many times medicaid cuts have really been made.