Ohio Healthcare Association Argues State Medicaid Reimbursement Rates Fall Short

Date May 13, 2024
Categories

The Ohio Healthcare Association (OHCA) is suing the state’s Medicaid program in the Ohio Supreme Court over its new reimbursement rates, which the OHCA contends are inadequate to cover the cost of providing quality care to Medicaid patients.

The OHCA represents hundreds of skilled nursing facilities, assisted living communities, and is a non-profit association that also advocates for home health and hospice service providers, as well as care and services for individuals with developmental and intellectual and developmental disabilities. This broad representation underscores the OHCA’s commitment to a healthy Ohio, collaborating with health systems to improve healthcare across the state. The Ohio Department of Medicaid distributes funding to 926 nursing homes serving more than 66,000 residents, an estimated 65 percent of Ohio nursing home residents.

“We tried every avenue to convince the department that they are misinterpreting the clear language of the statute, to no avail,” Pete Van Runkle, executive director of the OHCA, said in a statement. “Our members read the budget bill and expected a much stronger commitment to quality-based funding. They are extremely disappointed that it did not materialize.”1

The OHCA is joined in the suit by the Academy of Senior Health Sciences and LeadingAge Ohio.

The OHCA claims that the current reimbursement rates are so low that many facilities are struggling to cover their operating costs, let alone invest in upgrades or improvements to better serve their residents, what the OCHA describes as among the state’s most vulnerable citizens. The Association proposes that the reimbursement rates put the quality of care at risk and jeopardize the well-being of Medicaid beneficiaries who rely on these facilities for essential services. The lawsuit also raises concerns about the impact of the reimbursement rates on staffing levels and wages for healthcare workers.

The Ohio Department of Medicaid has argued that the rates are fair and in line with federal requirements, that they are set based on a formula that takes into account a variety of factors, including the cost of providing care, geographic variations, and other considerations. The Department maintains that they are committed to ensuring that Medicaid beneficiaries have access to quality care while also being responsible stewards of taxpayer dollars.

As the legal battle unfolds, stakeholders are monitoring the proceedings and considering the potential implications of the outcome. Healthcare providers, Medicaid beneficiaries, policymakers, and advocacy groups all have a vested interest in the outcome of the lawsuit, as they see it as having the potential to shape the future of healthcare in Ohio for years to come.

Justices with the Ohio Supreme Court have asked both parties to attempt mediation before moving ahead with court proceedings.

Ultimately, the lawsuit between the Ohio Healthcare Association and Ohio Medicaid shines a spotlight on the ongoing challenges facing the healthcare system in Ohio and underscores the need for comprehensive reform to ensure that all residents receive the care they need to lead healthy and fulfilling lives. 

HBK is a member of the OCHA and provides advising services to approximately 100 facilities within Ohio. For more information on how this development affects your organization, contact Josh Zarlenga at jzarlenga@hbkcpa.com

1Zuckerman, Jack. (2024, May 9). Nursing homes sue Ohio Medicaid, with hundreds of millions on the line. Cleveland. https://www.cleveland.com/open/2024/02/nursing-homes-sue-ohio-medicaid-with-hundreds-of-millions-on-the-line.html

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