Nursing homes await Medicaid payments

July 26--HAMILTON -- A delay in Medicaid payments through a new state program has left nursing homes across the state wondering if they can meet payroll demands and other costs.

Butler County Commissioners on Thursday approved an advance of $250,000 to the Butler County Care Facility, a 109-bed nursing home in Hamilton.

The care facility made the request earlier this week in order to make payroll during the month of August, said Chuck Demidovich, administrator at the care facility.

"I don't have a bank I can go to to get a line of credit," Demidovich said, who has 135 employees. "I believe there are homes out there that won't be able to make payroll and won't have lines of credit available."

The care facility is one of many across the state who've joined a three-year pilot program called MyCare Ohio, a managed care plan to coordinate benefits for those receiving both Medicaid and Medicare. The program launched May 1 in 29 Ohio counties.

Previously, skilled nursing facilities would directly bill the Ohio Department of Medicaid for services. But that billing is now done through five private insurance companies signed on to MyCare Ohio -- Aetna, CareSource, Buckeye, United and Molina.

Commissioner Don Dixon said it's obvious the system is not working well.

"This is no fault of the county home management; the state is behind in its payments," Dixon said. "It's going to cause a huge problem for the private sector people who can't do the advance; fortunately, the county home has us to write a check for the payroll."

Dixon said the $250,000 will come out of the county's contingency plan -- meant for times like this -- and will be repaid by the care facility.

Demidovich said the Butler County Care Facility -- using plans from Aetna and Molina -- submitted claims for the month of June on July 3. As of this week, he's gotten no notice the claims were accepted and no payments have come in.

"When we bill Medicaid one day, we get payment five days later," Demidovich said.

Sam Rossi, spokesman for Ohio Department of Medicaid, said there are currently 108,000 Ohioans enrolled in MyCare Ohio that are getting both Medicaid and Medicare assistance. Those patients are represented by over 29,000 health care providers.

"A handful of independent providers have had issues getting paid," Rossi said.

Rossi said the state doesn't have a way of knowing just how many providers are affected. He said providers experiencing problems with billing should contact their plan provider.

"The plans are the one paying them," Rossi said.

Rohan Hutchings, spokesman for Aetna, said the insurance company is aware of the billing problem and is working to resolve the issues.

"We have identified the problem with our systems and are implementing processes to resolve this as quickly as we can," Hutchings said in an email. "In the meantime, we are manually processing claims, increasing our check runs to twice a week and where required, offering cash advances to health providers."

Demidovich said he got no such offer from Aetna, and decided to be proactive in order to meet the demands of the three-paycheck month coming up in August.

In a July 24 health care advisors update from HW&Co., an Ohio accounting firm offering financial services to nursing homes, the company detailed the billing problems still prevalent three months after the launch of MyCare Ohio.

"Despite their best efforts, plans are still struggling to make accurate and timely payments to skilled nursing facilities for services provided," according to HW&Co. "Not only is this financially detrimental to providers, but the MyCare Ohio rollout has required an increased use of nursing home staff's time for billing and collecting, as they re-bill claims and study denials in an effort to understand how to get paid."

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