Budget Season Begins:  All Hands on Deck!

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

We are  pleased to share that some of the budget priorities requested by LeadingAge Ohio were included in the Governor’s executive budget for the 2018-2019 fiscal years, including rate increases for home- and community-based services and changes to Medicaid transportation.  We had also advocated for a payment model that would allow nursing facility members to receive additional dollars for quality outcomes; however, the Governor’s budget proposes cutting nursing facility reimbursement substantially.

We are grateful for the active engagement of the LeadingAge Ohio Board and its Advocacy Committee and subcommittees, which were instrumental in developing the priorities.   Our priorities included in the budget reflect 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

Though our LeadingAge Ohio nursing facilities’ (NF) priorities reflected a focus on quality that would have allowed for increased reimbursement, the Governor’s budget proposes projected cuts to skilled nursing facilities of approximately 7% across the biennium (3.3% in 2018; 3.9% in 2019). The budget includes:

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

These cuts and changes as proposed are untenable for our members to continue the provision of the highest quality care to our most frail Ohioans. We will continue to advocate to incentivize quality providers, while seeking restoration of the proposed cuts.

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; be assured, we will continue in our advocacy work! NOW is the time for LeadingAge Ohio members to tell their stories; these stories need to be heard by members of the Ohio General Assembly.  There will be many changes as the budget process moves through the House and Senate between now and June, to conference and then finally back to the Governor’s desk by June 30 and a clear, consistent message of the importance of our work needs to be conveyed.

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.

What You Can Do

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.