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The Ohio Caregiver Crisis and the Hoops That Block Access to Care

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In 2018, I wrote an article about the caregiver crisis in Ohio. Since then, it has gotten to an all-time extreme! It will get much worse. Ohio just created more hoops for independent providers by adding additional licensure and surety bond requirements in their latest Ohio budget bill.

Providers must file for a license to practice home healthcare by July 1st, 2022. This is required of providers who have two of more Medicaid or Aging clients. They are also required to obtain surety bonds. Most are based on credit. Home care doesn’t pay much and these added expenses can wreak havoc on an already low-paying industry that is struggling. Many providers in our state don’t have the greatest credit. Some of this is due to pay issues from 2014-2017 when the state forced dual-eligible consumers into managed care. Many providers went months without pay, damaging their credit scores. Some providers even ended up homeless or had to leave the field to support their families.

The impact on our providers’ credit scores really hurt them; as you know it takes only but few late payments to hurt those scores. Statistics shared recently in the Ohio budget bill hearings, cited that “53% of our providers are on some form of public assistance and 39% are on Medicaid.” We are adding an additional poverty burden to our workers that just isn’t fair.

These extreme hoops were baked into Ohio House Bill 110. Some may wonder, what is the motive behind this? Perhaps to take away consumer choice or maybe to cut down on fraud? No one is certain and all around both issues will make it so people cannot access care.

Ohio has more problems in home care than people really see on the surface level. The news media will never tell you that there are many systematic problems in Ohio’s system that make it so people can’t access home care. With challenges like the electronic visit verification systems and a poor rollout to complications in provider enrollment and contracting, Ohio has many messes they can’t seem to clean up, causing providers to leave the field.

Agencies are understaffed. During the May 13, 2021 budget hearing, we learned that some agencies have decreased the number of Medicaid clients they will take or have stopped taking Medicaid clients altogether because of low reimbursement rates. Medicaid independent provider directories are out of date and thousands of people cannot find care. It is ridiculous that my waiver case management called over 500 independent providers and agencies from four counties with little to no response. Some of this was due to disconnected phone numbers, people were no longer living and families couldn’t get them removed, wrong numbers, people left the field, etc.

The Breaking Silences Advocacy group out of Dayton, Ohio has held meetings with Medicaid, The Centers for Medicare and Medicaid Services, and other advocacy groups about issues in our home care system in Ohio to seek answers about all the issues happening in our state over the last year. They have even tried to understand the new licensure and surety bond requirements so we can help providers navigate what is to come.

The Ohio Olmstead Taskforce Direct Support Crisis workgroup sent a letter to the Ohio Director’s of Medicaid, Ohio Developmental Disabilities and Ohio Department of Aging in August asking for a plan of action with the caregiver crisis.
A raise was given to providers effective November 1, 2021. This will not fix the systemic problems that drive out our providers. It is also not a living wage. It doesn’t even add up to the undue burdens of inflation or the new costs that providers will be forced to pay to stay in the field.

Recently, the Ohio Olmsted Taskforce and Ohio Independent Living Centers held five forums around the state to educate and raise awareness about the direct support workforce crisis to state and local officials and the general public. These panels featured real-life stories from consumers on home and community-based waivers around the state. I was on one of these panels sharing my struggle to obtain aide and nursing care. Everyone who participated did a great job sharing their stories and also adding ideas on what the state could do to improve access and fix the challenges we face in Ohio with getting care. Some of the biggest remarks were about provider pay, overhauling the provider enrollment and contracting processes also getting rid of unjust hoops that were just added such as the surety bonds and licensure requirements.

Ohio is in a mess. There doesn’t seem to be much of a plan to clean up this mess. There must be a plan to deal with the looming caregiver crisis that includes the removal of these unjust burdens. State leaders from the Ohio Department of Medicaid, Ohio Department of Developmental Disabilities, and Ohio Department of Aging must be held accountable. The lack of accountability also runs deep in our legislative body. They vote on legislation that is harmful to our care, knowing it is a violation of our Olmstead rights.

Ohio must allow a free choice in providers. People need care. Living in the community with the right supports is a human rights issue. Accountability comes with courage. I am an artist and I painted nine feet of art on the Ohio Caregiver Crisis and used my art to advocate. We must go beyond the petition methodology and dial up our legislative body and email them and let them know this crisis that the disabled community and their providers are facing is inhumane and must be addressed.

Ohio is a hot mess, but we need all that are willing to speak up to do so. It is fraud on the part of the state to authorize care then create access barriers to that care. Tax dollars at work lining the administrators’ pockets while people are declining in their health or even dying because they can’t access care. It should have never gotten this bad. Ohio must be better!

Originally published: December 9, 2021
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