Springfield, MO

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Lt. Gov. Peter Kinder says he is appalled at the conditions of Missouri's Medicaid following the cancellation of its contract with SynCare.
Lt. Gov. Peter Kinder says he is appalled at the conditions of Missouri's Medicaid following the cancellation of its contract with SynCare.

Lt. Gov: State's Medicaid processing taking too long

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At an Oct. 17 news conference at Oxford HealthCare, Lt. Gov. Peter Kinder told a crowd of about 40 people that Gov. Jay Nixon’s administration and the Missouri Department of Health & Senior Services are not meeting obligations to Medicaid patients seeking home-health services.

State officials said in response that they are doing all they can to meet the requests of those in need.

On Aug. 31, DHSS terminated its $5.5 million contract with Indianapolis-based SynCare LLC, which had come under criticism for its handling of the state’s in-home Medicaid clients and applicants. In the weeks since DHSS fired the private assessment company, Kinder said service hasn’t improved.

Kinder said many of the 9,300 patients who were waiting to be assessed for in-home services on Sept. 1 are still waiting – despite the fact the state has hired 86 temporary workers to determine the eligibility of applicants in the absence of SynCare.

“I’m surprised, disappointed and, frankly, appalled at the utter failure of the administration of Gov. Nixon to address what is a crisis in care for some of Missouri’s most vulnerable citizens,” said Kinder, the state’s official senior advocate.

Kinder said he believes DHSS was too slow to react to problems reported from patients and providers after SynCare began managing assessments on orders from the governor and his office. Now that DHSS has taken on that responsibility, Kinder said the department is dragging its feet and not meeting the needs of those who want to stay in their homes and avoid more expensive options such as nursing homes.

A Medicaid patient receiving home-based assistance costs taxpayers an average of $6,000 per year, compared to $36,000 per year for nursing-home care, Kinder said.

“There are thousands of noncritical assessments that are still waiting to be done. Many of these noncritical patients are now considered critical because they have had to wait so long,” Kinder said, adding that reassessments and new assessments are also contributing to the backlog problem.

Springfield-based home health care provider Oxford HealthCare is part of a group offering to address the backlog of Medicaid patients seeking in-home care.

Oxford is partnering with Missouri Alliance for Home Care, Missouri Council for In-Home Services, Missouri Association for Assisted Living and the Centers for Independent Living, said Oxford Vice President Cheryl Fitch, who also serves on the MAHC board.

The department, however, has been unwilling to change its course, Fitch said.

SynCare began providing assessment services for the state on May 19. Previously, registered nurses provided the assessments, and proponents of private assessments said those same nurses were the ones who benefited from their recommendations. Kinder said he wasn’t opposed to a private system, but that those waiting in limbo to receive timely care needed to be the priority now.

Oxford was among the health care providers calling for a change from SynCare. Despite the fact that SynCare was required to make contact with applicants within three days and perform in-home evaluations within 15 days, patients often were waiting weeks or months to learn about the status of their applications, Fitch said. In early June, she said Oxford had a backlog of 30 requests for care, and by the end of August, the requests had risen to roughly 170. The company’s current backlog is 117 patients, with an average wait period of 61 days, according to Oxford Community Outreach Coordinator Julie Vanvig-Burnell.

State Rep. Thomas Long, R-Battlefield, said at the news conference that DHSS needed to allow registered nurses to resume the assessments until the current backlog is eliminated and a long-term solution is determined.

“What we don’t want to do as a state is force people into a higher level of care, not because they need it, but because we are being inept in how we provide care to those folks,” Long said.

DHSS Director of Public Information Jacqueline Lapine said DHSS has processed more than 6,800 cases with faster services and shorter wait times than under the private contractor. In addition to the temporary workers already hired, DHSS planned to hire another 19 assessors, supervisors and support staff. Lapine said via e-mail DHSS staff has handled more than 5,900 calls from participants and health care providers since Aug. 31, and finalized an average of 234 care plans per day, up from an average of 107 under SynCare.

Lapine provided a statement from DHSS Director Margaret Donnelly.

“Our priority is to provide Missourians with the services they need in the most efficient and effective manner possible. We have taken significant steps to field calls, conduct assessments and finalize care plans for the people we serve,” Donnelly said in the statement. “Moving forward, we remain committed to ensuring that services are delivered, processes are improved and each taxpayer dollar is carefully managed.”

Long said through talks with health care providers, he has become convinced that those same providers are best suited to deal with the state’s backlog.

“Who do you want providing the assessment for your grandparent, for the aged, for the blind, for the disabled? Do you want a temporary worker hired under an emergency clause by the state, or do you want an RN doing that?” he said. “I know who I want.”

State Sen. Jay Wasson, R-Nixa, said he feels the solution is simple.

“I don’t know why this needs to be that complicated,” Wasson said. “We’re not going to be able to work this through until providers start working those people through.”[[In-content Ad]]


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