Photos by Mackenzi Klemann | The Lima News
LIMA — For weeks, Mary Lewis has wondered what will happen to her caregivers if payment troubles persist between the Ohio Department of Medicaid and third-party billing sites.
Lewis was born with spinal muscular atrophy, a genetic neurological condition which weakened her muscles so much that she relies on a rotation of caregivers to get her out of bed, brush her teeth, cook her meals and assist with other daily tasks.
But Lewis’s caregivers, who are self-employed through an Ohio Medicaid waiver for disabled adults to receive home-based care, have been working without pay for weeks as the agency and third-party billing sites work to resolve site glitches.
“It’s been scary not knowing if my caregivers are going to get me up in the morning, because I can’t get out of bed without them,” Lewis said.
ODM did not return requests for comment on the scale and cause of the payment delays.
The problems started earlier this month when ODM switched to a new claims processing system, said Tiffany Krites, an independent caregiver who started working for Lewis two years ago.
Krites tried billing through other third-party sites and contacting ODM herself, to no avail. She hasn’t seen a payment since Feb. 2, she said on Saturday.
“If we don’t start seeing pay,” Krites said, “it’s going to get to the point where we’re going to start leaving, because we have to get another job that actually will pay us. We have bills ourselves, but where does that leave our clients?
“Mary’s dependent on me,” Krites said. “I’m her arms and legs throughout the day so she can do her daily living.”
The payment delays come as Ohio contends with a shortage of home health aides and independent caregivers, potentially jeopardizing care for disabled adults, who may need to move into long-term care facilities if they are unable to find enough home-based caregivers.
“I hear all the time: we can’t work for nothing,” Lewis said. “And I agree. It’s scary.”
“It’s sad,” said Alana Rankin, another independent caregiver affected by ODM payment delays, “because we do something really important. Without us, some of these people wouldn’t even be able to get out of bed.”
Update: An Ohio Department of Medicaid spokesperson on Thursday emailed the following response to The Lima News’ inquiry about delayed payments.
“As Ohio Department of Medicaid introduced foundational changes to its next generation of managed care, beginning with the July 1, 2022, launch of OhioRISE, the department offered providers interim options for submitting claims until we complete the full implementation of the Next Generation program.
“On Feb. 1, Ohio Medicaid introduced new, ‘next generation’ electronic data interchange (EDI) processes and requirements that support 90% of total provider claims that come to Medicaid. A majority of these are submitted by trading partners — outsourced IT vendors hired by providers to manage electronic billing, coding, transmissions, etc. — and most claims are being submitted as expected. However, the overall volume is lower than anticipated, indicating a percentage of trading partners have not yet tested nor become familiar with the new requirements.
As with any new system or process change, getting familiar with new steps and requirements takes time and practice. The department introduced a variety of provider and trading partner supports in preparation for the Feb. 1 transition including establishing technical teams that reached out directly to trading partners, training teams, and multiple provider help desks to resolve issues. We are working alongside providers, provider partners, and managed care plans to educate and train them on systems upgrades and to resolve technical barriers they may be experiencing. We are making constant improvements to adjust as problems are identified.”
