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, 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

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