Stuck with the bill: Payment concerns surrounding MyCare Ohio

But several medicaid providers in the Miami Valley reached out to 2 NEWS Investigates over the last few months saying they are not getting paid.

DAYTON, Ohio (WDTN) – What was supposed to be a new system that improves care for low-income Ohioans with disabilities while saving the taxpayer money ended up costing some small business owners.

They help care for low-income Ohioans with disabilities. But several Medicaid providers in the Miami Valley reached out to 2 NEWS Investigates over the last few months saying they are not getting paid.

Tanya Ellis and her husband Frank almost lost her business because of it.

“It’s really hurt us a lot. I actually had to sell my car to make ends meet,” said Tanya Ellis.

They transport Medicaid patients to the doctors office, dialysis, and to the hospital. But in July, they stopped getting paid for a majority of their runs. It was their only source of income.

“We’ve got to have gas, we have got to pay for insurance, we’ve got to pay bills,” said Ellis.

Ohio changed the way it handled some Medicaid claims this year by implementing a 3 year test program called, “MyCare Ohio.”

The goal is to create a more efficient system to integrate care for those on both Medicaid and Medicare. It also would save you, the tax payer, money in the long run. Ohio is currently testing out this idea in 29 counties including the Miami Valley.

Instead of getting paid directly by the government, providers like Ellis now have to go through private managed care plans assigned to their area. Ellis said her problems have been with the company, Buckeye Health Plan.

When we first starting asking questions, she said Buckeye owed her $7,234 for transporting patients.

“Since they took over it’s been a disaster,” she said.

2 NEWS Investigates found Ellis wasn’t the only provider not getting paid. We received several calls from others in the same situation.

So we tracked down Beverley Laubert. She’s the state’s long-term care ombudsman; the one who deals with complaints against the program.

Natalie: Why weren’t these companies, these providers, getting paid?
Laubert: “Well I think there were communication issues.”

Laubert said since MyCare’s implementation in May, they’ve had 195 complaints, and she’s aware of several issues involving home health providers not getting paid.

“We had some issues up front with some of the smaller independent providers having issues with their claims and being paid by the managed care companies,” said Laubert.

Buckeye admitted to the payment problem with Ellis. They told 2 NEWS in part, “Buckeye was experiencing communications issues on what services the Provider was providing. As it became more clear what the services were, we were able to give the provider a clear direction on how to proceed going forward and how to submit claims for those services.”

Laubert said there’s an intense review of everything happening with the MyCare test program. She said all kinks are reported to state and federal agencies.

Natalie: Do you think that issue is being fixed?
Laubert: “It is, yes. A little at a time. I’m sure there are some people who feel like they are not being paid fast enough, it’s probably not moving fast enough but yes, they have a list and they are working through their list.”

Since 2 NEWS Investigates started asking questions, Ellis has received a majority of the money she was owed. But that hasn’t changed her mind when it comes to the new program. She has a strong message for those behind it.

“They are not organized at all, they really need to communicate better so everybody is on one page,” said Ellis.

Laubert said the providers who are not getting paid need to take their own action by contacting these private health care plans as well as the state to let them know there’s a problem.

She said the Director of Medicaid has been vocal in letting the managed care companies know they need to get this problem straightened out.

WDTN: MyCare Ohio

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