Governor proposes changes affecting independent providers of home care

March 5, 2015 / independent providers

Many people with disabilities receive home and community-based services (for example, a personal care aide, a home health aide, or a nurse) through Medicaid, which allow them to receive the support they need in the community and to avoid unnecessary institutionalization.

Generally, under the current system, a person may choose one of two types of providers: an agency provider or an independent provider. An agency provider is a company that has employees who are sent to the person’s home to provide services, and an independent provider is an individual worker who provides services directly.

Because of changes in federal labor laws, the governor’s FY 2016-17 state budget proposes major reforms to this system. Under the proposal, the state, beginning on July 1, 2016, would begin to phase-out Medicaid payments to independent providers. Ohio Medicaid would not accept any new independent providers after this date, and those independent providers whose certification is expiring would not have the chance for renewal. By July 1, 2019, Ohio Medicaid will accept claims only from agency providers.

There is an important exception to these proposed changes. A person would still be able to choose an independent provider if he or she is enrolled in a “self-directed” (also known as “participant-direct” or “consumer-directed”) waiver program. This means that the person directly manages his or her budget and the services he or she receives, including hiring, supervising, and directing the individuals who provide services and negotiating payment rates to these individuals.

Right now, only the SELF waiver, the PASSPORT waiver, and MyCare Ohio have self-directed options, but state officials have indicated that they will ask the federal government to have this option available for all waiver programs.

Since the governor’s proposal was announced, many people have called DRO with concerns about losing access to providers whom they trust and with whom they have developed strong, close relationships. DRO is reviewing and monitoring the issue and working with its coalition partners to better understand the initiative and how it would affect people with disabilities. 

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