Careless2

June 19, 2014 at 10:57 AM (Uncategorized) (, , , , , , , )

I am at a loss. The Medicaid HMO that is supposed to be handling home health care for me is not. Plain and simple. I am receiving nursing care and dressing changes for my foot which is good but my health is in jeopardy because I cannot go to the wound care clinic thar I need to go to to monitor the wound on my foot. The reason I cannot go is that I cannot properly dress without assistance at the same time and that assistance is being withheld because the Medicaid HMO that I am under cannot get its provider database in order to pay those independent aides who work or want to work for me. I have someone in the afternoons but I need someone in the mornings. I’ve checked with agencies as well and they’re unable to find anybody that needs to work in the time frame that I need them who is able to get paid for their time. Because I don’t have assistance getting a protective boots onto my right foot in the morning the wound is growing bigger there is too much pressure on it. My health is at risk, because the private health insurers which  the state of Ohio put in place to assist its most vulnerable population with community-based care are a hopeless non functioning mess. Clients cannot post requests for aides. Most aides have not been paid for over a month now. My Medicaid HMO does have a database where they can enter their information once they provide the correct identifying documents to caresource via fax but the number and type of these documents needed to become a provider are never clearly stated: Temporaries working the phones ask for different material each time they call and they are told that certain items are valid one later it turns out they are invalid. ( as an aside ineffective or sloppy or lazy phone customer service work really burns my bacon because I used to do that for a living  and I know that if I didn’t have all the conditions and illnesses that I have now I could  do better than these people. ) There is also a problem with the payment system. Even when it is used correctly the amount
of the first hour is always calculated differently than later hours used and the Medicaid Hmo system does not seem to take that into account. It is unable to provide the aide with their correct hourly rate, to let them know what they are paid. This is important because there have been changes in state law about what they should be paid and how they should be paid.

That means that the current state of affairs is that any aide who is not getting paid because they are improperly loaded into the system or not loaded at all has refused to work and in some cases left clients until they are paid. The threat of losing their license seems to mean little to them because they’ve been working so long without pay. But I’ve done all the looking I’m going to  do. It should not be my job to chase down procedures or fixes for a computer system that should never have gone online if it was unable to pay those who are scheduled to serve the most vulnerable Medicaid patients in the state. You’d think they would have learned a lesson from a less than stellar roll out of healthcare.gov, but apparently no one in the State House was watching TV or reading newspapers when that went down. This change its been discussed since 2002. They have had a very long time to design this and get it right. I’m going to name names now because I imagine the other two Medicaid HMO’s that are allowed to do business in the state are having the same type of problems with paying their
people, because all three have the same pool of agencies or independent home health aides to work from. It is a very difficult job that these aides do and they should not be expected to work without pay because some programmers sitting somewhere else couldn’t get their s*** together.

I’m going to write I’m going to email I’m going to call and I’m going to Internet like crazy until Caresource, United Healthcare, and Buckeye, provide services required by the state to Medicaid patients and provide the monies to their caregivers so the caregiving can begin or continue. the three companies required to replace Medicaid in the state of Ohio for those Medicaid beneficiaries who had Medicare as well I.e dual eligibles.

My caseworker alone has 93 clients to see
to. That’s one small sliver of one of the companies cases.

Another case worker is said to have stated  that caresource is just overwhelmed with the new people and clients are just going to have to stay with whomever they have for now. Even if whomever they have is inadequate for their needs. This is mind blowing  but I suppose I should have expected it. Medicaid patients are the most invisible people in this country so if something goes wrong with our care nobody generally talks about it until after our health is compromised or after we’re already gone.

This is not an acceptable state of affairs not for me and not for my fellow dual eligibles in state.

You will hear more of this from this space as it goes on

3 Comments

  1. Michele said,

    I have been a Home Health Aid in Ohio for four years, I have always worked for the same client. This change over to Caresource (and I assume Buckeye and United) has been nothing short of a DISASTER for we aides.

    My client has three aides, NONE of us are getting paid on a regular or timely basis. I waited for 6 weeks before I received a check after the change over, and I have not been paid since July 11th. The excuse we keep getting is their billing dept is overwhelmed due to we independent aides. BULLCRAP! Hire more workers then. Why were we all getting paid on a weekly basis before the switch to Caresource??? The problem lies directly with CS, we had ZERO problems getting paid before the switch, when we were paid via Child and Family Services.

    Caresource has been screwing people over for a looong time, check these links from 2010, well before Obama Care, which Gov Kasich’s office is blaming for these problems. I call BS on that excuse as well, but no one cares what I think, obviously.

    http://www.springfieldnewssun.com/news/news/local/company-says-caresource-not-paying-clients-bills/nNtdp/

    http://www.springfieldnewssun.com/news/news/local/clients-caught-in-health-care-dispute/nNtdn/

    We love our client, she is a wonderful person who deserves the very best, but she is not getting anything close to the best from Caresource. All three of us might have to quit if this situation isn’t straightened out soon. Our client will be forced into a nursing home if this happens, because who will replace us and be willing to work without knowing when or how much you will be paid? NO ONE, that’s who. My client also has a teenage son. Where will he go? This is SUCH a mess.

    I wish you the very best, and thank you for this blog. No one seems to care about the problems of the disabled/elderly/infirm or the people who care for them.

    • imfunny2 said,

      Thank you so much. I feel like I’ve been talking in the dark about caresource since the switch over. From what I can tell the only way that really works to get paid or at least so that your claims showing processing to learn the system to load your hours directly into caresource without an intermediary such as. diserve. A lot of aides are quitting because the process is a giant pain in the neck. It also doesn’t leave room to document the spend down it’s crazy.

      • Michele said,

        Believe me, trying to find answers about this mess online is like trying to find teeth in a hen’s mouth, honey. This is RIDICULOUS! My poor client is freaking out that she is going to have to go into a nursing home, and I am freaking out that I will end up sleeping in my car before this all shakes out o_0

        I don’t get where all the aides and nurses are, (online) The commotion was loud and clear when Kasich voted to cut our first hour wage two years ago. Some one set up a Facebook page that was crazy for two weeks until they took it down. And the outraged forum posts are still archived at allnurses.com. But this time? Nothing, nada, zip.

        Caresource is going to continue to screw with us, I am convinced. Big changes are coming in the Home Care industry in 2015. I think they are trying to get rid of all of us IPs before the end of the year.

        http://www.dol.gov/whd/regs/compliance/whdfsFinalRule.htm

        I am afraid even if we can hang on that long we will get the boot when this ruling goes into effect. Hope I am wrong. And I hope I get paid this week.

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