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How Ohio's Medicaid bundling affects residents

January 17, 2010
by Kathleen Mears
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My power wheelchair is a year old and will soon need new batteries. Medicaid used to purchase batteries once a year. Most of my batteries were replaced after they had gone dead. But, my old power chair was pretty easy to push in free wheel mode. When I contacted my provider about getting new batteries, I was told the nursing facility must now pay for my batteries and any repairs to my power chair.

A few months ago I noticed that a male resident on my unit no longer used an oxygen tank attached to his wheelchair. He was switched to an oxygen concentrator which pretty much ties him to an electrical plug. When I said something to the oxygen delivery man, he said the government had changed things again. I wondered how much using a concentrator would curtail that resident's activities. Most residents here only have the option of using a concentrator. But many of them only leave their rooms to go to the dining room for meals.

All of these changes have to do with Medicaid bundling here in Ohio. The state legislature used this option last year to help bring more Medicaid dollars into Ohio and balance the state budget. Medicaid bundling affects residents who need physical and occupational therapy, medical transportation, oxygen, and specialized wheelchairs (such as power chairs). Medicaid gives the facility an allowance each day for each resident to pay for these bundled services. Previously, nursing homes billed Medicaid for them. No one knows yet whether these fees will be adequate for facilities to provide the services that were formerly reimbursed. It is just expected that facilities will be able to do a better job and therefore keep costs down. Even after reading several articles I am a bit at a loss to figure out the Medicaid pay formula.

From what I have read nursing homes are not complaining about Medicaid bundling. But some facilities that deal mostly with neurological disabilities are concerned about the costs related to power chair maintenance and repair. Also, many nursing home residents are concerned that they will no longer have functional power chairs to keep them from being in bed all the time.

One thing this will mean for me is I will not know when I will get new batteries when these go dead. Also, there is danger in allowing someone to go out in a power wheelchair whose batteries are more than a year old and might die at any time. Over the years power wheelchairs have more features and are heavier. Therefore, pushing a dead power chair in free wheel mode is not easy.

Now we residents who have power chairs have to wonder how long our batteries will last. When I lived on my own, Medicare paid for my batteries. I even had them replaced by the provider when I was working in downtown Columbus. After I came here I was private pay for a while and purchased my own batteries. Before I became Medicaid eligible my sister purchased them. The fee then was $350; now they cost more than $500. I feel an essential part of my life is disrupted whenever there is a problem with my power chair.

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Kathleen,
We (nursing facilities) certainly are complaining about bundling, but no one in government is listening. It is not reasonable for Medicaid to believe that giving facilities a few dollars per day for bundling will not affect care and services, when one custom wheelchair can cost thousands of dollars. It is just another way for the state to cut costs and then put the blame on the "evil" nursing facilities who just want to maximize profit. Many of us are just trying to keep our doors open, let alone make a profit.

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Kathleen Mears

www.ltlmagazine.com/blog/kathleen-mears

Kathleen Mears has been a nursing home resident in Ohio for 20 years. She is an incomplete...