Amendment could endanger key program for children, advocates say

Jun. 15—COLUMBUS — Mark Butler and his wife came to the heart-wrenching decision that they had to surrender custody of their severely autistic and increasingly violent son, Andrew, in 2014 in order to get him the intensive help he needs but was beyond their financial means.

Now, just as a new program is to go on line to help parents like the Butlers, of suburban Columbus, keep custody and find help close to home, they and other child advocates fear it could be derailed by an amendment recently slipped into the proposed state budget.

That amendment would force Ohio to redo its recent selection of managed-care providers elsewhere in the system.

At the urging of state Sen. Theresa Gavarone (R., Bowling Green), Senate Republicans added the language to address a dispute involving Maumee-based Paramount Advantage, an insurance subsidiary of ProMedica. Paramount, which employs about 600 in the Toledo area, was the sole current managed-care provider to not get a contract through the new process.

"If this procurement process gets halted, there is simply going to be eulogies for the hopes and dreams of people like me for system change, because it's going to kill OhioRISE," Mr. Butler said. "That's not acceptable."

Championed by Gov. Mike DeWine, OhioRISE (Resilience through Integrated Systems and Excellence) is slated to go into effect next year. It is designed to provide specialized, often expensive treatment for children with multiple and behavioral problems so severe and complex that sometimes services can't be found in Ohio.

The focus of the new program would be to provide that treatment at home or in community settings.

While not directly impacted by the mandatory restart of the managed-care provider selection process, the program's backers argue that the tentacles of managed care are so interwoven with other aspects of Medicaid that it can't help but delay, if not scuttle, the program's launch.

"The entire budget is built on this procurement moving forward, so if it gets canceled, they have to redo the entire actuarial review, redo each of those contracts, and even then they would probably get sued from the awardees," said Loren Anthes, who leads the Center for Community Solutions' Medicaid policy center.

"They would have to terminate pharmacy benefit managers," he said. "It would be like throwing a grenade."

The budget anticipates hundreds of millions of dollars in savings from the managed-care reforms, part of which is expected to help pay for OhioRISE.

"What has me seeing red right now is that a parent [Thursday] had to surrender custody of their kid to get help," Mr. Butler said. "Forced custody relinquishment has been Ohio's most disgusting secret for a long time."

In a statement, ProMedica and Paramount said conclusions that the redo of the selection process will negatively impact programs like OhioRISE are wrong, pointing to Ms. Gavarone's attempt to exempt the program.

"OhioRISE is separate from the (managed-care organization) procurement process, and there is no reason it should be impacted by the proposed budget amendments to address the flaws in the MCO procurement process," it said. "Paramount supports the lawmakers' recently proposed budget amendments because there is truly so much at stake, including the loss of 600 Ohio jobs, disruption of managed care for nearly a quarter of a million Ohio Medicaid members, and the loss of $81 million annually in Ohio community spending and contributions."

It added that it supports OhioRISE and its implementation next year.

Last week Senate Republicans again tinkered with the procurement language to exempt OhioRISE from its provisions, but Gayle Channing Tenenbaum, Medicaid consultant for children and youth with the Center for Community Solutions, said that all it did was preserve the issue for further debate in conference committee.

The Republican-majority, six-member committee will begin the process Tuesday of trying to hammer out a compromise between the versions of a $75 billion, two-year budget passed by the Senate and House of Representatives.

A final plan must reach Mr. DeWine's desk by the end of the fiscal year. He has line-item veto authority to strike any language he doesn't like before signing the budget into law.

The Department of Medicaid approved new contracts with six managed-care providers in April, but Paramount did not make the cut.

The Senate amendment would require the department to conduct the process over again in 2022, this time giving preference to companies based in Ohio. The state must also take into consideration the number of jobs affected and other economic impacts as well as whether a company already has a proven track record when it comes to quality and customer satisfaction.

Ms. Gavarone, one of the three senators who will serve among the conferees, said she will continue to work to preserve Paramount as a Medicaid provider.

"Impacting OhioRISE was never the intention," she said. "I will certainly do what I can to narrow the language. OhioRISE is an important program...

"I think Paramount is really an important provider of Medicaid to our area," she said. "It's an important employer and important to the economy up in our area. Right now we're coming out of a global pandemic, and I want to make sure that the 240,000 people are still getting their services through Paramount."

The new managed-care reforms were the culmination of about three years of talks for a $20 billion Medicaid program that serves some 3 million lower-income adults and children.

Paramount has appealed the department's decision not to award it a new contract and has sued the department in the Ohio Court of Claims for documents related to the scoring and decision-making process it says it needs for that appeal. Paramount received the second-lowest overall score among the applicants.

Senate President Matt Huffman (R., Lima) has said frustrations among lawmakers about getting information from the DeWine administration played a role in the decision to use the state budget to force the issue.

The current budget and the proposed next budget both include funding designed to help parents meet the financial demands of intensive treatment and services for their children, but advocates argue that fund was always seen as a temporary bridge to OhioRISE's launch in January.

First Published June 15, 2021, 8:11am