RI Business Blasts $600K in Medicaid Cuts as Hurting “Most Vulnerable”
Wednesday, April 08, 2015
A Rhode Island business is raising questions about recent changes in Medicaid reimbursement rates affecting the state's children and elderly, as the "Reinventing Medicaid" working group appointed by Governor Gina Raimondo is currently identifying ways to save an addition $88 million in Medicaid cuts.
Sean Delong, a logistics manager for Sensational Child, a North Kingstown business that provides family services, including diapers to children - and adults -- in need who are covered by Medicaid, spoke to the impact that recent cuts in reimbursement rates have on his business and clients.
"They think they're saving $600,000 in state dollars in savings, but at what cost?" asked Delong. "The state was willing shell out millions [of dollars] for 38 Studios. My small business is one of the largest suppliers of incontinence products in the state, we deliver to over 700 people monthly, and if the cuts go through that they have proposed, it's going to be an enormous negative impact on everyone that we and other providers get supplies for."
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTDelong noted he was only recently made aware that Medicaid has lowered the reimbursement rates on diapers based on changes made last year, which his company purchases and delivers to Medicaid-covered patients, by 20% to 50%, depending on the product. Delong said he was only notified in March of the changes by someone in the industry, and had to call the state's Medicaid office to verify.
"It's as if they tried to quietly sweep the cuts under the rug, and of course attack the most vulnerable population in the state," said Long. "We've been reimbursed for a fixed amount for each product. Per diaper, Rhode Island's [Medicaid reimbursement] is a little higher than other states. Because of our low overhead, we've been able provide a high quality product product. But I've heard stories about lesser quality products, about homes having to double up diapers. It's not just embarrassing, it's inhumane."
New Changes Defended -- and Challenged
Delong noted that the changes were put into motion before Governor Raimondo indicated she would be addressing Medicaid cuts, but he spoke out in anticipation of further conversations surrounding Medicaid.
"What we're hoping for is that they realize there are areas we realize need to be addressed, we know our Medicaid budget is fairly high, but cuts of this nature will have such a tremendous impact on the quality of product," said Delong. "As far as our business goes, it will be difficult to keep the doors open in general now with this." Delong noted that in the office besides himself, there were two additional office works as well as the director, and the business employed 22 special needs adults for operations.
Michael Raia, Communications Director for the Rhode Island Office of Health and Human Services, said that the existing reimbursement rates were why the changes were put into effect last year.
"We are constantly looking at our reimbursement rates and make changes to ensure we're providing the best value for the taxpayer and best service for our beneficiaries. It's an ongoing process. Bringing Rhode Island's reimbursement rate for these diapers and similar supplies in line with our neighboring states will save Rhode Island $600,000 this year," said Raia.
"We're confident that providers can continue to provide Rhode Island families with a quality product at a cost to state taxpayers that is consistent with what our neighbors in Massachusetts and Connecticut reimburse," said Raia. "Before the proposed amendment, Rhode Island's reimbursement rate for these supplies was between two and three times the national average."
Delong countered the state's assessment of the projected cost savings, however.
"In black and white, saving $600,000 in taxpayer dollars looks good, but they're not considering the other costs. People will be using more products, skin rashes and bacterial infections, which will equal more medication and hospital visits, said Long. "Not to mention the pure lack of humanity that a lousy product will mean for the consumers and the people caring for them. It's one thing changing a baby's diaper, image someone from the age of 10-50 that is wearing a product that doesn't work, it's completely inhumane."
Provider Perspective
Mary Burdick, a staff member at a group home on Tower Street in Westerly that uses the services of Sensational Child, said that the cuts could be devastating for members of the home.
"Our residents can't afford to buy all the diapers they need on their own, to go out and pay for them themselves -- so they rely on Medicaid for this, said Burdick. "We can't pick and choose products now. The lesser quality ones are less absorbent, and there will be that much more embarrassment if there are accidents, to their dignity and reputation."
"Currently, we have six residents, and only 4 use those products, but down the road, their situations could change," said Burdick. "What I do now, I call [Sensational Child] and say who needs the products and here's their insurance, and so far, [Medicaid's] covered anything. I don't know what they would do now. It's not fair, and it's not right. The state is always making cuts to services for the most in need."
Raia noted that an upcoming meeting on April 24 would consider the amended changes.
"The April 24 meeting is a hearing facilitated by EOHHS. It's not a legislative hearing. Rhode Island law requires EOHHS to grant an oral hearing on a proposed Rhode Island Medicaid State Plan amendment if 25 people, an agency or an association with at least 25 members requests a hearing," said Raia. "We have posted a public notice and will provide an opportunity for anyone who is interested to provide testimony."
Long said he plans on contesting the cuts.
"We could have just folded [our business] and accepted the cuts and just sent out lousy products to all of these homes, but as someone who has worked in the field for so many years, I just can't sit back and let this happen without some kind of fight," said Long. "Someone needs to stand up for these guys."
Related Slideshow: Health Data Security Breaches Reported in RI Since 2010
The following are health data breach reports from Rhode Island as listed on the Department of Health and Human Services Office of Civil Rights website.
As required by section 13402(e)(4) of the HITECH Act, the Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals. These breaches are now posted in a new, more accessible format that allows users to search and sort the posted breaches. Additionally, this new format includes brief summaries of the breach cases that OCR has investigated and closed, as well as the names of private practice providers who have reported breaches of unsecured protected health information to the Secretary.
.png)
Related Articles
- NEW: Cicilline Pushes for Medicare, Medicaid and Social Security Protection
- NEW: State Saves Millions from Medicaid Reforms
- NEW: Assembly Seeks to Address Medicaid Fraud
- NEW: Company Sues State over Medicaid Cuts
- New Report: Medicaid Number One State Budget Cost
- AG Candidate Says RI Needs to Go After More Medicaid Fraud
- Pharmaceutical Fraud Settlement Recovers More Than $170K for RI Medicaid
- $500 Million in Stimulus Funding Went Toward Medicaid Costs
- NEW: Medicaid Fraud in Pawtucket
- NEW: RI’s Neighborhood Health Plan Named #4 Medicaid Plan in US
- Rhode Island Chosen for $20 Million Healthcare Payment by Centers for Medicare and Medicaid Services
- RI State Report: Medicaid Fraud, Kidnapping + Seat Belt Laws
- New Allegations Surface in RI Medicaid Fraud
- NEW: Group Calls on RI to Opt Out of Health Exchange and Medicaid Expansion
- Smart Benefits: Will Paul Ryan’s Plan for Medicare + Medicaid Fly?
- Raimondo Announces Formation of Working Group to Reinvent Medicaid in RI
