By Timothy Cox
A number of agencies and county Alcohol, Drug Addiction & Mental Health Services boards across the state are calling for reform of a Medicaid system they say is bankrupting the public mental health and chemical dependence treatment system.
Officials at Tri County ADAMHS, which serves Mercer, Van Wert and Paulding counties, have been watching mandated local matching dollars for Medicaid gobble up more and more money over the past couple of years. The payouts come at a time when Tri County's budget already is strained.
"The statistics say, and the trend is, we're moving toward becoming a Medicaid-only system," Tri County Executive Director Keith Turvy said.
Without reform, the "medically indigent" will be left virtually with no available services, Turvy said. Medically indigent are people who work full-time but have no health insurance and are not eligible for Medicaid. Local agencies now charge for services on a sliding scale based on income. If Medicaid patients account for the entire system, though, sliding scales will be gone and waiting lists will grow longer, Turvy said.
The Ohio Commission to Reform Medicaid, formed by the state Legislature in 2003, is charged with making recommendations for comprehensive reform and cost containment of the state's Medicaid rules and regulations. The commission's final report is due Jan. 1, 2005. Behavioral health professionals from across the state recently testified before the commission about how current Medicaid rules are putting the financial squeeze on an array of programs. "Because Medicaid is an entitlement, non-Medicaid services are being reduced or eliminated to meet the demand for Medicaid match. Boards are now finding themselves in a position of turning people away who are seeking behavioral health services," Ohio Association of Behavioral Health Authorities CEO Cheri Walter told the commission. "Individuals who have a Medicaid card must be given priority for services ... Under current circumstances in many (ADAMHS) board areas, meeting the needs of those with Medicaid ... consumes all the available resources."
Walter also noted common complaints from local boards that they retain no control over how Medicaid dollars are spent or control over direct treatment of patients.
"The lack of any meaningful utilization review, let alone care management, prevents boards from controlling unnecessary care as a result of unjustified extended stays, or in instances where clients receive more intensive and more costly care than is necessary," Walter said.
Jay Salvage, executive director of the Lucas County ADAMHS, which includes the Toledo area, told the commission that almost all funding his board receives from the state is spent on the local Medicaid match. Projections for the current budget year show $1,281,951 in state allocations that can be divided among local agencies, Salvage said. But non-Medicaid patients will have almost no access to the funding, with $1,154,505 going toward the board's Medicaid match.
Ron Rees, executive director of the Washington County Mental Health and Recovery Board, testified to the commission about a single Medicaid-only provider in that county gobbling up all of the available matching money. After spending just under $35,000 for the Medicaid match in 2000, the bill hit $323,269 for the fiscal year that ends today.
"Services once provided to non-Medicaid consumers have had to be curtailed or eliminated completely," Rees said. "Without any control over the Medicaid agencies, we cannot fund other services we deem necessary. And that defeats the whole purpose of the board."
Locally, Tri County spent $48,000 four years ago on Medicaid match for local residents seeking treatment outside the three-county area, Turvy said. That number reached $120,000 last year and is expected to be around $100,000 for the budget year that ends today.
Tri County officials closely track those out-of-area payments although they also hold contracts worth millions with other local agencies that serve Medicaid patients.
Martha Briem, who heads the ADAMHS board for Tuscarawas and Carroll counties, said the current atmosphere makes it possible for some Medicaid providers to act unethically. One agency in her area reportedly has been booking appointments and services based on what Medicaid will pay rather than what services might be needed. The same agency is adding new services aimed at children, who often are covered by Medicaid.
The association of behavioral health professionals offered several suggestions on how the state commission can revamp Medicaid and solve some of the most urgent problems. They include:
´ Creating new state rules that allow local boards utilization review and care management.
´ Freezing any expansion of Medicaid-eligible programs by the Ohio Department of Alcohol and Drug Addiction Services and the Ohio Department of Mental Health until new controls are in place.
´ State officials should be more stringent in certifying Medicaid-eligible providers.
´ State officials should consider requiring other social support systems to share in the payment of the local Medicaid match.
´ Local boards should contract with service providers based on community needs in regards to demand, quality and cost of services. Medicaid providers should not be allowed unfettered access to provide whatever services they want.
"This has to be done. It absolutely has to be," Turvy said of the proposed reform.