As of Thursday, Feb. 11, Vale said CareSource had not contacted her about alternative home health care.
CareSource, which has 1,548 members in Clark and Champaign counties under Medicaid’s Aged, Blind or Disabled program, did not receive any such notice, said Bobby Jones, CareSource chief operating officer.
“It’s kind of amazing this has gone this far and (Interim) not having changed their behavior,” he said. “We’re giving them reasons for why claims are not processed. I don’t understand why it has gotten to this point.”
Last week Vale paid cash for one visit from a home health aide, but cannot do that on a regular basis.
“CareSource collected money from the federal government for my home health care but they’re not paying their bills,” she said. “Who’s that money going to?”
According to Ohio Department of Job and Family Services, JFS makes a monthly capitation payment for each Medicaid consumer enrolled in a Medicaid Managed Care Plan (MCP).
“MCPs use this capitation payment to provide all medically necessary services that are covered by the Medicaid program for their medical services,” JFS spokesman Brian Harter said. The MCP receives payment regardless of whether an individual consumer receives services during the month of payment.
As of 2008, individuals under Medicaid’s Aged, Blind or Disabled program could not be enrolled in straight Medicaid but had to choose an MCP.
Interim is not the only agency that has had issues with the managed care companies, said Kathleen Anderson, executive director of the Ohio Council for Home Health Care and Hospice Care.
“The Department of Job and Family Services used to pay the providers for those services, but once managed care took over it really changed the landscape,” Anderson said. “It slowed down to a screeching halt as far as the speed of reimbursement.”
The company began having issues with Vale’s claims soon after she started receiving care in 2008, Smith said. Each of the seven terminated clients represent an average of $4,000 in unpaid claims, he said.
Managed Care companies are required, by contract with JFS, to pay 90 percent of correctly submitted claims within 30 days, Harter said. Ninety-nine percent of correct claims must be paid within 90 days.
“CareSource is responsible for assuring access to medically necessary services that the consumer needs and is required to assist the consumer in this instance in locating a home health agency who will provide services,” Harter said.
CareSource would have done that, had it known its member was going without, Jones said.
“If there is a possibility of a member out there that is not receiving car,e it’s simply a matter of calling us,” Jones said. CareSource will be contacting all of their members using Interim to see if they’ve had an interruption of care, he said.
“In the terms of the $48,000 ... we try to be very open, honest and forthright with our providers,” Jones said. “If the money is owned to Interim, I will pay it.”
Any CareSource customer who has lost home health care services is asked to call CareSource’s customer service line at (800) 488-0134.
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