Governor's Budget Includes Challenges and Opportunities for Providers

LeadingAge Ohio members are well aware of the complexities of managing reimbursements across the continuum. The Governor’s budget, released Monday, reflects that tension. The budget includes both challenges and opportunities for LeadingAge Ohio members, which are summarized below.

LeadingAge Ohio is pleased to share that some of the budget priorities for which it has been advocating were included in the Governor’s executive budget for the 2018-2019 fiscal years. LeadingAge Ohio is grateful for the active engagement of its Advocacy Committee and subcommittees, as well as the Board of Directors in the development of these priorities.  Those priorities include  changes to transportation and home and community-based services (HCBS):

HCBS Changes

• Increases rates for home- and community-based services by $61 million
  • Increases and restructures assisted living waiver reimbursement
  • Increases PASSPORT and Ohio Homecare Waiver personal care aide rates
  • Increases rates for adult day, emergency response and home delivered meals
• Provides support for individuals who want to self-direct their care

Transportation Changes

• Creates a new brokerage model to create one-stop shop for those in need of transportation
• Consolidates transportation services at Ohio Medicaid instead of county Departments of Job and Family Services

As previously reported in The Source, this is a tight budget due to a $1 billion shortfall in revenues in the current fiscal year. Cuts to Medicaid providers were expected.  The proposed Medicaid budget decreases Ohio’s Medicaid expenditures by $1.8 billion across the biennium. Unfortunately, there are projected cuts to skilled nursing facilities of approximately 7% across the biennium. 

NF Changes

• $215 million overall cut to reimbursement over the biennium
• Resetting unintended payment gains resulting from RUG-IV implementation
• Moving nursing facility reimbursement out of statute
• Incorporating PA1 and PA2 rates into case mix adjustment
• Moves the remainder fee-for-service LTSS into managed care

Additionally, the Ohio Department of Medicaid (ODM) was able to apply for a waiver from the Centers for Medicaid and Services (CMS) for a replacement assessment applied to Medicaid managed care plans, as well as non-Medicaid managed care plans. The waiver was approved in December 2016, eliminating the $1 billion shortfall.  

Additional anticipated policy changes in the Governor’s budget include:

• Moving remaining Medicaid populations from fee-for-service into managed care
• Supporting performance payments for comprehensive primary care
• Adopting a single preferred drug list for the Medicaid pharmacy benefit
  

Members may also review the Administration’s analysis of changes related to Care Coordination, Home and Community-based Services, and Provider Payments for more detail.

It is important to note that this is just the beginning of the legislative budget process. To date, LeadingAge Ohio has worked with the Administration to incorporate our budget requests; LeadingAge Ohio member voices now need to be heard by members of the Ohio General Assembly.  There will be many changes as the process moves through the House and Senate between now and June, to conference and then finally back to the Governor’s desk by June 30th.

Additionally, it is important for members to consider the budget in the larger context of federal health reform: significant changes to Medicaid are expected in any replacement for the Affordable Care Act (ACA), which may force the legislature to take up the budget again if the ACA replacement if passed after Ohio’s budget.

The Governor will release budget details in the coming week, and LeadingAge Ohio members may expect a more comprehensive analysis with talking points for members immediately following. Budget season requires “all hands on deck” from our grassroots advocates, so members are encouraged to log into the LeadingAge Ohio Action Center, so they are ready to mobilize.

LeadingAge Ohio is looking forward to working with the Administration and General Assembly to strengthen Ohio’s system of long-term services and supports, to ensure Ohioans have access to high-quality, patient-centered care that maximizes their ability to age well.

Any questions about the budget may be directed to Kathryn Brod, President/CEO at kbrod@leadingageohio.org or Nisha Hammel, Director of Advocacy, at nhammel@leadingageohio.org.