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00:00:00>> SUPPORT FOR "THE STATE OF
OHIO" COMES FROM THE LAW OFFICES
00:00:04OF PORTER, WRIGHT, MORRIS &
ARTHUR LLP, HELPING BUSINESSES
00:00:09AND INDIVIDUALS SOLVE COMPLEX
LEGAL PROBLEMS THROUGHOUT OHIO,
00:00:12ACROSS THE COUNTRY AND AROUND
THE WORLD -- ON THE WEB AT
00:00:14PORTERWRIGHT.COM. AND FROM THE
OHIO EDUCATION ASSOCIATION,
00:00:17REPRESENTING 131,000 TEACHERS,
SUPPORT PROFESSIONALS AND HIGHER
00:00:20EDUCATION FACULTY WHO ARE
WORKING FOR GREAT PUBLIC SCHOOLS
00:00:23FOR EVERY CHILD, ONLINE AT
OHEA.ORG.
00:00:28>> THE HEARTBEAT BILL IS REVIVED
AT THE STATEHOUSE.
00:00:38AND AS HEARINGS ON MEDICAID
REFORM BEGIN, THE STATE'S
00:00:40MEDICAID DEPARTMENT IS QUIETLY
UNDERGOING A TRANSFORMATION INTO
00:00:42A NEW AGENCY THAT HOPES TO BE
MORE USER-FRIENDLY AND COST-
00:00:44EFFICIENT.
THE DIRECTOR OF THE NEW
00:00:46DEPARTMENT OF MEDICAID IS HERE
TO TALK ABOUT THAT AND THE
00:00:49CONTINUING QUESTIONS SURROUNDING
THE POSSIBILITY OF MEDICAID
00:00:52EXPANSION.
ALL THIS WEEK IN "THE STATE OF
00:00:53OHIO."
AFTER DYING AT THE END OF THE
00:00:55LAST GENERAL ASSEMBLY, THE SO-
CALLED HEARTBEAT BILL IS BACK
00:00:57AGAIN.
THE MEASURE THAT WOULD BE AMONG
00:01:00THE MOST RESTRICTIVE ABORTION
LAWS IN THE COUNTRY WAS
00:01:02REINTRODUCED THIS WEEK BY
REPRESENTATIVE CHRISTINA HAGAN,
00:01:05A REPUBLICAN OF ALLIANCE.>>
THERE IS A LOT OF FOLKS WHO SAY
00:01:12YOU SHOULD NOT WORK ON SOCIAL
ISSUES, BUT IN FACT ECONOMIC
00:01:17ISSUES AND SOCIAL ISSUES GO
HAND-IN-HAND.
00:01:19WHEN WE HAVE 20 THOUSANDS OF
CHILDREN WHO ARE ABORTED ON AN
00:01:25ANNUAL BASIS IN THE STATE OF
OHIO, AND WE HAVE 70,000
00:01:29UNFILLED JOBS, THERE MIGHT BE A
CORRELATION.
00:01:30>>
HAGAN WAS JOINED BY SOME OF THE
00:01:3440 REPUBLICAN COSPONSORS OF THE
BILL, AND BY REALITY TV STARS
00:01:36JIM BOB AND MICHELLE DUGGAR AND
17 OF THEIR 19 KIDS.
00:01:38HAGAN, ALONG WITH THE PREVIOUS
HEARTBEAT BILL'S SPONSOR,
00:01:40REPUBLICAN REPRESENTATIVE LYNN
WACHTMANN OF NORTHEAST OHIO, PUT
00:01:45-- OF NAPOLEON, IN NORTHWEST
OHIO,
00:01:51PUT FORWARD THE BILL THAT WOULD
BAN ABORTIONS AT THE FIRST
00:01:53DETECTABLE FETAL HEARTBEAT,
WHICH CAN BE AS EARLY AS SIX
00:01:55WEEKS INTO A PREGNANCY -- BEFORE
MANY WOMEN KNOW THEY'RE
00:01:57PREGNANT.
THIS NEW BILL ALSO MANDATES
00:01:58INSPECTIONS OF ABORTION CLINICS,
AND INCLUDES A COMMISSION TO
00:02:00STUDY WAYS TO IMPROVE ADOPTION
IN OHIO.>> TO THOSE WHO SAY WE
00:02:07HAVE A WAR ON WOMEN, I WOULD
REMIND YOU THE REAL WAR ON WOMEN
00:02:10ARE THE ABORTIONISTS, THE
SLAYERS OF THOSE YOUNG BABIES,
00:02:16THE YOUNG GIRLS IN THE MOTHER'S
MALONE, WHO TAKE THEIR LIVES.
00:02:22THAT IS THE REAL WAR ON WOMEN.
>>
00:02:26LAST TIME AROUND, THE HEARTBEAT
BILL HAD DIVIDED ANTI-ABORTION
00:02:28ADVOCATES, WITH OHIO RIGHT TO
LIFE OPPOSING IT ON THE GROUNDS
00:02:30THAT IT WAS UNCONSTITUTIONAL.
FORMER SENATE PRESIDENT TOM
00:02:32NIEHAUS HAD WANTED RIGHT TO LIFE
AND HEARTBEAT BILL SUPPORTERS TO
00:02:34COMPROMISE BEFORE HE WOULD BRING
THE BILL TO A VOTE, BUT THAT
00:02:36NEVER HAPPENED.
A BILL INTRODUCED THIS WEEK
00:02:38WOULD REQUIRE CITIES, VILLAGES
AND COUNTIES TO BALANCE THEIR
00:02:40BUDGETS, JUST AS THE STATE IS
OBLIGATED TO DO UNDER ITS
00:02:42CONSTITUTION.
THE BILL FROM REPRESENTATIVE LOU
00:02:45TERHAR, A REPUBLICAN OF
CINCINNATI, WOULD ALSO REQUIRE
00:02:47ALL GOVERNMENTAL SUBDIVISIONS TO
MAINTAIN ACTUARIALLY FUNDED
00:02:50MUNICIPAL PENSION PLANS.
TERHAR SAYS BANKRUPTCY FILINGS
00:02:56FROM DETROIT AND STOCKTON,
CALIFORNIA, ARE REMINDERS OF WHY
00:02:59OHIO'S GOVERNMENTAL SUBDIVISIONS
SHOULDN'T BE LEFT OPEN TO
00:03:01POTENTIAL FINANCIAL CRISES.
BUT A SPOKESMAN FOR THE OHIO
00:03:07MUNICIPAL LEAGUE SAYS CITIES ARE
ALREADY REQUIRED TO HAVE
00:03:10BALANCED BUDGETS IN ORDER TO
AVOID SCRUTINY FROM THE STATE
00:03:13AUDITOR'S OFFICE.
AND KENT SCARRETT NOTES THAT
00:03:16CITIES ARE HAVING A HARD TIME
RIGHT NOW TRYING TO MAKE ENDS
00:03:19MEET, ESPECIALLY SINCE THE STATE
HAS MADE DRASTIC CUTS IN LOCAL
00:03:22GOVERNMENT FUNDS AND TAKEN AWAY
LOCAL REVENUE THROUGH ESTATE
00:03:25TAXES.
THE OHIO ETHICS COMMISSION CHAIR
00:03:29SAYS GOVERNOR JOHN KASICH MADE A
CLEAN BREAK FROM WORTHINGTON
00:03:33INDUSTRIES, WHOSE SUBSIDIARIES
RECEIVED $619,000 IN TAX BREAKS
00:03:36FROM THE STATE.
AN ASSOCIATED PRESS REPORT THIS
00:03:41WEEK DETAILED KASICH'S
LONGSTANDING FINANCIAL AND
00:03:43POLITICAL TIES TO WORTHINGTON
INDUSTRIES, INCLUDING HIS BOARD
00:03:45SALARY AND DEFERRED COMPENSATION
PAYOUTS INTO 2011.
00:03:53CHAIRMAN MEROM BRACHMAN SAID THE
LAW MAKES IT CLEAR THAT THE
00:03:55ETHICS COMMISSION HAS NOTHING TO
DO WITH THE JOB-CREATING ENTITY
00:03:58JOBSOHIO, AND THAT ITS ONLY ROLE
IN POLICING THE RELATIONSHIP
00:04:02BETWEEN KASICH AND WORTHINGTON
INDUSTRIES IS TO ASSURE KASICH'S
00:04:05PAYMENTS FROM THE COMPANY WERE
ACCURATELY REPORTED.
00:04:10HEARINGS ON A BIPARTISAN PLAN TO
REFORM MEDICAID BEGAN THIS WEEK
00:04:13IN COLUMBUS, AND WILL CONTINUE
FOR THE NEXT FEW WEEKS AROUND
00:04:15THE STATE.
THIS PARTICULAR BILL, SPONSORED
00:04:18BY SENATORS DAVE BURKE, A
REPUBLICAN FROM MARYSVILLE AND
00:04:22CAPRI CAFARO, A DEMOCRAT OF
HUBBARD NEAR YOUNGSTOWN, WOULD
00:04:26MAKE CHANGES TO THE PROGRAM TO
TRY TO CONTAIN COSTS.
00:04:29BUT IT WOULD NOT EXPAND
MEDICAID, AS GOVERNOR JOHN
00:04:32KASICH WANTS TO DO.
A BILL SPONSORED BY REPUBLICAN
00:04:36REPRESENTATIVE BARBARA SEARS OF
SYLVANIA WOULD DO THAT, BUT IT
00:04:37HAS YET TO BE SCHEDULED FOR A
HEARING.
00:04:41AND A BILL INTRODUCED RECENTLY
BY SENATOR CAFARO WOULD DO BOTH
00:04:44BUT AGAIN, IT HASN'T HAD A
HEARING AND LIKELY WON'T FOR
00:04:48QUITE A WHILE, IF AT ALL.
MEANWHILE, THE STATE'S MEDICAID
00:04:51DEPARTMENT HAS BEEN UNDERGOING A
TRANSFORMATION.
00:04:54THE NEW DEPARTMENT OF MEDICAID
WAS CREATED IN THE STATE BUDGET
00:04:57WITH THE GOAL OF MAKING THE
MASSIVE MEDICAID SYSTEM MORE
00:04:59EFFICIENT, COST-CONSCIOUS AND
USER-FRIENDLY.
00:05:03AND IT TAKES ADVANTAGE OF
TECHNOLOGY WHILE ALSO CREATING A
00:05:06NEW MANAGED CARE PROGRAM AND
PUTTING MONEY INTO HOME AND
00:05:09COMMUNITY BASED CARE.
WITH A BUDGET OF NEARLY $44
00:05:13BILLION, MEDICAID IS BY FAR THE
STATE'S LARGEST EXPENDITURE.
00:05:18AND WITH 2.4 MILLION OHIOANS
ALREADY ON MEDICAID AND AS MANY
00:05:22AS 275,000 PEOPLE WHO COULD COME
INTO THE SYSTEM IF MEDICAID IS
00:05:26EXPANDED, THIS IS AN AGENCY THAT
COULD REACH MORE THAN 23% OF
00:05:30OHIO'S POPULATION.
TO TALK ABOUT ALL THIS AND MORE,
00:05:35I'M HAPPY TO WELCOME STATE
MEDICAID DIRECTOR JOHN MCCARTHY
00:05:38TO THE SHOW.LET US START WITH
THIS NEW AGENCY.
00:05:42YOU SET THE BEST NEWS HERE IS
THAT NO ONE NOTICED THAT YOU
00:05:47TRANSITIONED INTO A NEW AGENCY.
TELL ME ABOUT THAT.
00:05:49>> WE WERE LOOKING AT HOW TO
REFORM MEDICAID -- WHAT NEEDED
00:05:56TO BE DONE.
ONE ISSUE WAS, THE DEPARTMENT
00:06:00WAS WITHIN THE DEPARTMENT OF
JOBS AND FAMILY SERVICES.
00:06:03WE WERE ONE OF THREE DEPARTMENTS
BEING RUN.
00:06:09WE HAVE SISTER AGENCIES.
HOW COULD WE ALIGN THE DIFFERENT
00:06:13DEPARTMENTS THAT WORK TOGETHER
ON IMPROVING THE PROGRAM?
00:06:17ONE IDEA WAS THAT WE WOULD BE A
STAND-ALONE AGENCY.
00:06:21WE COULD ACT QUICKER, MAKE
DECISIONS QUICKER, AND MOVE
00:06:26THROUGH SOME OF THE NORMAL
PROCESSES THAT ANY GOVERNMENT
00:06:31AGENCY HAS TO MOVE THROUGH.
ONE OF THE THINGS I WAS HOPING
00:06:37FOR WAS, NOBODY WOULD NOTICE.
OBVIOUSLY, PEOPLE FOUND OUT.
00:06:42THAT WOULD USUALLY MEAN
SOMETHING WENT WRONG.
00:06:43WE HAVE SEEN SMOOTH OPERATIONS.
INTERNALLY, THINGS HAVE HAPPENED
00:06:49SMOOTHLY.
EXTERNALLY, PEOPLE HAVE NOT SEEN
00:06:53A CHANGE, BESIDES THE NAME ON
OUR BUILDING.
00:06:54HOW DO WE USE THOSE NEW
ABILITIES, OR NIMBLENESS, TO
00:07:04MAKE CHANGES QUICKER?
HOW DO WE MAKE CHANGES MORE
00:07:06EFFECTIVELY SO THAT PEOPLE FROM
THE OUTSIDE START SEEING MORE
00:07:09IMPROVEMENT MORE RAPIDLY?
>> IT IS AS SIMPLE AS PAPER
00:07:15APPLICATIONS VERSUS DOING THINGS
ONLINE, AND DECISIONS MADE AT
00:07:19THE COUNTY LEVEL.
TALK ABOUT WAYS YOU ARE NOT ONLY
00:07:23TRYING TO SAVE MONEY FOR THE
STATE, BUT ALSO MAKING THE
00:07:28SYSTEM EASIER FOR RECIPIENTS AND
PROVIDERS.
00:07:29>> THERE ARE A COUPLE OF
DIFFERENT AREAS WHERE THAT COULD
00:07:33HAPPEN.
IN DOING DIFFERENT I.T. PROJECTS
00:07:37TO PROCURE THINGS, HOW CAN WE DO
IT QUICKER?
00:07:40IF THERE WAS A PROCUREMENT
COMING UP, WE WOULD BE IN LINE
00:07:47BEHIND THE OTHER PROGRAMS TO
HAVE THINGS GO OUT, BECAUSE
00:07:49THERE ARE ONLY SO MANY PEOPLE
WHO CAN REVIEW PROCUREMENTS TO
00:07:53HAVE THOSE THINGS HAPPEN.
NOW, WE ARE PRIORITIZING
00:07:57OURSELVES, SO THOSE THINGS GET
TO BE DONE FIRST.
00:08:02HE HAVE A NEW ELIGIBILITY SYSTEM
THAT IS GOING TO BE COMING UP IN
00:08:06JANUARY.
THAT WAS SOMETHING WE HAD TO DO
00:08:10BECAUSE OF THE AFFORDABLE CARE
ACT.
00:08:11THAT SAID, THE WAY WE DO
ELIGIBILITY FOR CURRENT AND
00:08:17ROWLEY'S HAS TO BE CHANGED.
IT IS NOT SOMETHING WE COULD NOT
00:08:20DO.
WE HAD TO DO IT.
00:08:21AS PART OF THAT, WE HAVE TO BE
ABLE TO DO ONLINE APPLICATIONS,
00:08:27WITH THE ABILITY TO TELL
SOMEBODY IF THEY ARE ELIGIBLE
00:08:30INSTANTANEOUSLY.
THAT IS WHAT THE AFFORDABLE CARE
00:08:34ACT SAYS.
IN THE CURRENT SYSTEM, YOU
00:08:39SUBMIT YOUR INFORMATION ONLINE,
AND IT GOES TO, BASICALLY, A
00:08:43COUNTY WORKER WHO WORKS THE
CASE, AND YOU GET A YES OR NO
00:08:46DETERMINATION LATER ON.
THAT IS NO MORE.
00:08:50IT WILL HAPPEN IMMEDIATELY.
YOU WILL GO ONLINE AND FILL OUT
00:08:54THE APPLICATION.
IT WILL TELL YOU YES OR NO
00:08:57INSTANTANEOUSLY.
COMING IN JANUARY, THAT IS
00:09:01SOMETHING INDIVIDUALS WILL BE
ABLE TO SEE VERY QUICKLY.
00:09:03IT IS A VERY BIG CHANGE.
FOR PROVIDERS, WE ARE FOCUSING
00:09:08ON HOW WE MAKE THEIR LIVES
EASIER.
00:09:09HOW DO WE MAKE THE PROGRAM LESS
ADMINISTRATIVELY BURDENSOME?
00:09:13WITH THE NEW SYSTEMS WE HAVE PUT
IN PLACE, WE ARE TRYING TO MAKE
00:09:19IT EASIER FOR THEM TO DO CHANGES
-- FOR THEM TO MAKE CHANGES TO
00:09:22THEIR ENROLLMENT, CHECKING HOW
CLAIMS ARE BEING PAID, WHAT IS
00:09:28GOING ON.
WE HAVE GONE TO A PAPERLESS
00:09:30SYSTEM WHEN IT COMES TO CLAIMS
PAYMENT.
00:09:32THEY SUBMIT THEIR CLAIMS
ELECTRONICALLY.
00:09:35WHAT DOES THAT MEAN?
CLAIMS GET ADJUDICATED FASTER.
00:09:39WE BASICALLY PAY A CLAIM BETWEEN
WHEN WE GET IT AND WHEN THE
00:09:45CHECK GETS OUT THE DOOR -- IT IS
SEVEN DAYS AT MAXIMUM.
00:09:47THOSE ARE SOME OF THE
IMPROVEMENTS WE HAVE BEEN
00:09:50WORKING THROUGH.
IN ADDITION, IT IS OVERALL, WHAT
00:09:56ARE THE POLICIES OF THE PROGRAM?
WHAT DO WE COVER?
00:09:59WHAT DO WE NOT COVER?
HOW DO WE LOOK AT IT?
00:10:04THIS IS HOW WE HELP INDIVIDUALS
BETTER BE SERVED.
00:10:07RECENTLY, WE WERE LOOKING AT --
WE COVERED HEARING AIDS, BUT
00:10:13ONLY ONE.
IF A PERSON NEEDED NUMBER OH --
00:10:17NEEDED 2 HEARING AIDS, THEY
COULD NOT GET 2?
00:10:19WHY WOULD WE DO THAT?
THOSE ARE CHANGES WE ARE MAKING.
00:10:25NOW, WE WILL BE PAYING FOR 2
HEARING AIDS, INSTEAD OF JUST
00:10:31ONE.
>> YOU HAD A NEW MANAGED CARE
00:10:35SYSTEM THAT STARTED ON JULY 1,
WHICH REDUCED THE NUMBER OF
00:10:38MANAGED CARE REGIONS FROM EIGHT
TO THREE.
00:10:40IT ALSO CONSOLIDATED
POPULATIONS.
00:10:42TELL ME ABOUT WHY THIS IS NEEDED
AS PART OF WHAT YOU ARE DOING
00:10:47HERE.
>> TO GET AN UNDERSTANDING OF
00:10:51WHY, WE HAVE TO GO BACK IN
HISTORY A BIT.
00:10:54WE HAD EIGHT REGIONS.
THEY WERE SOMEWHAT CENTERED
00:10:59AROUND URBAN CENTERS.
WITHIN THE EIGHT REGIONS, THERE
00:11:02WERE 2 SEPARATE CONTRACTS.
WE WOULD HAVE MANAGED CARE
00:11:07CONTRACTS.
YOU HAVE TO HAVE 2 ON EACH
00:11:10CONTRACT.
ON ANY OF THOSE EIGHT REGIONS,
00:11:13WE COULD HAVE 4 DIFFERENT
COMPANIES, BUT ONLY FOCUSING ON
00:11:16CERTAIN POPULATIONS -- CHILDREN
AND FAMILIES, THE DISABLED.
00:11:24YOU WOULD HAVE FAMILIES THAT
WERE SPLIT.
00:11:25YOU WOULD HAVE A FAMILY WITH A
PARENT AND CHILDREN, AND ONE OF
00:11:30THE CHILDREN WAS DISABLED.
YOU COULD HAVE THE FAMILY IN ONE
00:11:35MANAGED CARE ORGANIZATION, AND
THE CHILD WITH A DISABILITY IS
00:11:38IN A COMPLETELY DIFFERENT
ORGANIZATION.
00:11:39HOW ARE YOU COORDINATING CARE?
HOW ARE YOU WORKING THROUGH
00:11:44THOSE ISSUES?
IT AT COMPLEXITY FOR THE HEALTH
00:11:47PLANS.
WHEN WE LOOKED AT THE REGIONS,
00:11:50WE SAID, HOW CAN WE MAKE IT MORE
STREAMLINED?
00:11:53WHY DO WE HAVE 2 SEPARATE
CONTRACTS?
00:11:56NO REASON.
WE COMBINED.
00:11:59WE ALSO LOOKED AT THE EIGHT
REGIONS.
00:12:01WE REDUCED THOSE TO THREE
DIFFERENT REGIONS.
00:12:04WHEN WE DID THE NEW PRETERM AND,
PLANS COULD BID ON ONE REGION, 2
00:12:09REGIONS, OR THREE REGIONS.
ALL THE PLANS -- THERE ARE FIVE.
00:12:14THEY BID ON ALL THE REGIONS.
IN ESSENCE, WE HAVE FIVE PLANS
00:12:21THAT ARE NOW STATEWIDE.
HOW DOES THAT HELP THE PERSON?
00:12:23PREVIOUSLY, IN A REGION, IF YOU
WERE IN THE CHILDREN AND
00:12:28FAMILIES PROGRAM, YOU WOULD ONLY
HAVE A CHOICE OF 2 MANAGED-CARE
00:12:32PROGRAMS.
NOW, YOU HAVE A CHOICE OF FIVE.
00:12:36AS A PERSON, YOU HAVE MORE
CHOICE OF WHICH PLAN YOU CAN GO
00:12:39INTO.
FOR THE PLANS, NOW THEY HAVE
00:12:43MORE PEOPLE IN THEM, SO THE
ADMINISTRATIVE COSTS, WHICH ARE
00:12:46SOMEWHAT FIXED, GOES DOWN PER
PERSON.
00:12:48WHAT WE ARE ABLE TO DO IN THE
BUDGET IS SAVE MONEY, BECAUSE
00:12:54THE AMOUNT OF MONEY WE PAY PLANS
FOR ADMINISTRATIVE COSTS, WE
00:12:57REDUCED.
IT IS A WIN FOR THE STATE, IT
00:13:01FROM THE STANDPOINT THAT OUR
COSTS GO DOWN.
00:13:02PEOPLE GET MORE CHOICE.
IF THEY DO NOT LIKE ONE PLAN,
00:13:08THEY CAN SWITCH TO ONE OF THE
OTHER 4.
00:13:10FOR THE PLAN, NOW THEY ARE
STATEWIDE.
00:13:13THEY DO NOT HAVE TO WORRY ABOUT
PEOPLE MOVING ACROSS REGIONS.
00:13:16FOR THEM, ADMINISTRATIVELY, IT
MAKES IT EASIER.
00:13:21>> ONE THING PEOPLE TALK ABOUT
WITH COST-CUTTING IS WASTE,
00:13:25FRAUD, AND ABUSE.
THAT IS ONE OF THE EASIEST AREAS
00:13:29TO TALK ABOUT.
HOW ARE YOU DEALING WITH WASTE,
00:13:33FRAUD, AND ABUSE?
AND ARE THE SAVINGS ENOUGH TO
00:13:36REALLY STAVE OFF THE INCREASES
IN COST BECAUSE OF GROWTH?
00:13:39>> WHEN YOU ARE LOOKING AT
WASTE, FRAUD, AND ABUSE,
00:13:47SOMEBODY ALWAYS SAYS, WHAT
PERCENTAGE OF THE PROGRAM?
00:13:50OBVIOUSLY, IF WE KNEW THE EXACT
PERCENTAGE, WE WOULD GO AFTER
00:13:53THAT.
THERE IS IDENTIFYING, AND THEN
00:13:56THERE IS PROSECUTION.
ACROSS THE NATION, PEOPLE LOOK
00:14:00AT OHIO, WHAT WE ARE DOING IN
THIS AREA.
00:14:02WE HAVE A GROUP CALLED THE
PROGRAM INTEGRITY GROUP THAT
00:14:06WORKS WITH THE MEDICAID FRAUD
CONTROL UNIT IN THE ATTORNEY
00:14:09GENERAL'S OFFICE.
THAT UNIT HAS BEEN RATED AS ONE
00:14:13OF THE TOP THREE IN THE NATION
FOR THE LAST COUPLE OF YEARS.
00:14:15THEY DO A GREAT JOB ON
PROSECUTING PROVIDERS WHO HAVE
00:14:21COMMITTED FRAUD AND ABUSE.
THAT DOES NOT HAPPEN ALL THE
00:14:24TIME.
MY TEAM WORKS CLOSELY WITH THEM
00:14:27TO CREATE THE CASES TO BE ABLE
TO GET THE PROSECUTION TO
00:14:31HAPPEN.
>> IT SHOULD BE SAID, IN OHIO AT
00:14:33LEAST, THAT PROVIDERS ARE
RESPONSIBLE FOR MORE ABUSE THAN
00:14:39RECIPIENTS, ACCORDING TO YOUR
DEPARTMENT.
00:14:40>> THAT IS CORRECT.
IF I AM A PERSON COMMITTING
00:14:44FRAUD AND ABUSE, THERE IS ONLY
SO MUCH SERVICE I CAN GET.
00:14:48IF I AM A PROVIDER, BILLING FOR
A BUNCH OF PEOPLE I HAVE NOT
00:14:54SEEN, OBVIOUSLY, THE DOLLAR
AMOUNT IS MUCH LARGER IN THAT
00:14:56AREA.
WE ALSO FOCUS ON AREAS WHERE,
00:14:59NATIONALLY, YOU SEE MORE FRAUD
AND ABUSE.
00:15:02THAT IS DURABLE MEDICAL
EQUIPMENT AND HOME HEALTH.
00:15:06THOSE ARE AREAS WHERE,
NATIONALLY, THERE HAVE BEEN
00:15:11ISSUES.
IN OHIO, WE HAVE FOCUSED ON
00:15:15THOSE AREAS TO MAKE SURE WE ARE
CATCHING PROVIDERS WHO ARE
00:15:18FRAUDULENTLY BILLING.
>> THAT MONEY -- IS THAT ENOUGH
00:15:22TO DEAL WITH THE HUGE GROWTH IN
SPENDING YOU HAVE SEEN IN YOUR
00:15:25AGENCY? >> I AM GOING TO ADDRESS
THE ISSUE OF THE HUGE GROWTH.
00:15:31THE RECOVERIES THAT WE GET
CANNOT OVERCOME THE GROWTH IN
00:15:36THE PAST.
BUT THE GROWTH OF THE PROGRAM
00:15:39WAS FOR MANY OTHER REASONS THAN
FRAUD AND ABUSE.
00:15:41THE GROWTH WAS FROM DIFFERENT
WAYS THE PROGRAM WAS BEING
00:15:45MANAGED.
WHAT WE DID IN THE LAST COUPLE
00:15:50BUDGETS WAS ADDRESS THOSE ISSUES
AROUND GROWTH, AND THE
00:15:53UTILIZATION PATTERNS, AND WHERE
ARE MORE SERVICES BEING USED,
00:15:58LOOKING AT PROVIDER RATES,
MOVING RATES FROM JUST PAYING
00:16:01FOR QUANTITY TO ADDING
COMPONENTS TO THAT TO MAKE SURE
00:16:05WE ARE GETTING VALUE FOR WHAT WE
ARE PAYING FOR.
00:16:07BASICALLY, HOW DO WE IMPROVE
HEALTH OUTCOMES AND REWARD
00:16:13PROVIDERS THAT GIVE BETTER
HEALTH OUTCOMES?
00:16:14ART OF WHAT WE DID WAS THROUGH
MANAGED-CARE PLANS.
00:16:17WE TIED THEIR PERFORMANCE TO
PAYMENTS.
00:16:21SO WE WERE HOLDING ONE PERCENT
OF THEIR RATES BACK.
00:16:23IN THIS BUDGET, WE PROPOSE TO
HOLD TWO PERCENT BACK.
00:16:28THAT IS TIED TO BETTER OUTCOMES.
THAT IS HOW YOU GET CHANGES IN
00:16:35THE GROWTH OF THE PROGRAM TO
HAPPEN.
00:16:36WE ARE NOT GROWING AT 10%, LIKE
WE WERE.
00:16:38WE ARE GROWING AT FOUR PERCENT.
>> I WANT TO MOVE INTO A
00:16:45DISCUSSION OF MEDICAID
EXPANSION, WHICH IS NOT
00:16:49HAPPENING, BUT IS BEING
DISCUSSED A LOT.
00:16:51THE NUMBERS OF MEDICAID
RECIPIENTS IN OHIO HAVE BEEN
00:16:55STEADILY RISING OVER TIME.
THE NUMBERS OF MEDICAID
00:16:59PROVIDERS IN OHIO ARE AT A
LITTLE MORE THAN 100,000 RIGHT
00:17:03NOW.
AS YOU LOOK AT MEDICAID
00:17:05EXPANSION AND THE AFFORDABLE
CARE ACT TOGETHER, ARE THE
00:17:08NUMBERS OF PROVIDERS FOR
MEDICAID DROPPING?
00:17:10SOME PEOPLE HAVE QUESTIONS ABOUT
WHETHER FEWER PEOPLE ARE GOING
00:17:15TO BE PROVIDING MEDICAID FOR THE
GROWING NUMBER OF RECIPIENTS.
00:17:18>> WE ARE NOT SEEING THE NUMBER
OF PROVIDERS DROPPED.
00:17:22THAT IS SOMETHING I HAVE BEEN
ASKED A NUMBER OF TIMES IN
00:17:25HEARINGS.
THE NUMBER IS NOT DROPPING.
00:17:28WE ARE SEEING A STEADY INCREASE
IN PROVIDERS COMING INTO THE
00:17:32PROGRAM AS MEDICAID IS COVERING
MORE INDIVIDUALS WHO PREVIOUSLY
00:17:37HAD BEEN UNINSURED.
PROVIDERS ARE NOW ENTERING THE
00:17:43PROGRAM.
ALWAYS, WE ARE CONCERNED ABOUT
00:17:44ACCESS.
IT IS ALWAYS SOMETHING WE ARE
00:17:47MONITORING.
IT IS A REASON WE WORK WITH
00:17:50MANAGED-CARE PARTNERS.
THEY ARE ABLE TO, IN SOME WAYS,
00:17:54BE MORE NIMBLE AND ABLE TO
CONTRACT WITH PROVIDERS
00:17:56DIFFERENTLY THAN WE ARE IN A FEE
FOR SERVICE PROGRAM, BECAUSE OF
00:18:02FEDERAL RULES AND REGULATIONS.
OUR MANAGED-CARE PARTNERS HELP
00:18:05US FILL IN THOSE ACCESS GAPS, IN
ORDER TO BE ABLE TO CONTRACT
00:18:09WITH SOME PROVIDERS WE COULD NOT
DO IN A FEE FOR SERVICE PROGRAM.
00:18:11>> WHEN PEOPLE START CRITICIZING
THE IDEA OF MEDICAID EXPANSION,
00:18:18YOU HEAR CRITICS SAY THAT
MEDICAID ITSELF IS A BROKEN
00:18:19SYSTEM.
THE OUTCOMES INDICATE IT IS
00:18:23BROKEN, AND PUTTING MORE PEOPLE
ON THE SYSTEM WOULD NOT HELP.
00:18:27I WANT YOU TO ADDRESS THAT.
>> ALL OF THE DATA WE HAVE SEEN
00:18:31AROUND THAT THAT HAS BEEN
BROUGHT TO THE HEARINGS IS BASED
00:18:33ON NATIONAL DATA, NOT OHIO-
SPECIFIC DATA.
00:18:36THE OTHER ISSUE IS, HOW HAS IT
BEEN CONTROLLED, THE STUDIES
00:18:42THAT HAVE BEEN DONE?
YOU ARE LOOKING AT PEOPLE IN
00:18:47MEDICAID.
REMEMBER, WE DO NOT COVER,
00:18:48CURRENTLY, INDIVIDUALS WHO ARE
CHILDLESS ADULTS, NO MATTER HOW
00:18:54POOR THEY ARE.
THAT MEANS YOU ARE AN ADULT WHO
00:18:57DOES NOT HAVE A CHILD LIVING AT
HOME WITH YOU UNDER THE AGE OF
00:19:0118.
YOU COULD BE 50 YEARS OLD AND
00:19:03HAVE GROWN CHILDREN, AND YOU ARE
CONSIDERED A CHILDLESS ADULT.
00:19:07NO MATTER HOW POOR YOU ARE, YOU
CANNOT GET INTO THE PROGRAM AS
00:19:13IT STANDS.
HOW DOES THAT PERSON GET HIM?
00:19:14WHEN THEY BECOME DISABLED.
THOSE INDIVIDUALS, THEY HAVE
00:19:20DIABETES OR SOME OTHER
CONDITION.
00:19:22THEY GET SICKER AND SICKER,
UNTIL FINALLY THEY BECOME SO
00:19:26SICK THAT THEY ARE DISABLED.
I CANNOT WORK.
00:19:29THEY APPLY FOR DISABILITY.
THEY GET INTO THE PROGRAM.
00:19:31WE ARE CATCHING THEM AT A POINT
IN THEIR LIVES WHERE WE HAVE
00:19:37MISSED FIVE YEARS OF BEING ABLE
TO TREAT THEM.
00:19:41THE CHANCES OF THAT PERSON DYING
SOONER IS GREATER, BECAUSE THEY
00:19:47HAVE NOT GOT THE PREVENTIVE CARE
BEFOREHAND.
00:19:48BUT IN THE OHIO PROGRAM, WHAT WE
SEE, WORKING WITH MANAGED-CARE
00:19:53PARTNERS, IS, HOW DO WE MAKE
SURE WE ARE MEASURING THEIR
00:19:59PERFORMANCE AND SEEING BETTER
HEALTH OUTCOMES?
00:20:01WE ARE FOCUSED ON CHANGING
PAYMENT STRUCTURES TO MAKE SURE
00:20:03THAT IS HAPPENING, NOT JUST WITH
MANAGED-CARE PARTNERS, BUT
00:20:08HOSPITALS, COMMUNITY PROVIDERS,
TYING PAYMENT TO IMPROVING
00:20:13HEALTH OUTCOMES.
WE WILL GO BACK TO THE ISSUE OF
00:20:17A PERSON IN OHIO WHO HAD NO
INSURANCE.
00:20:18THAT PERSON WITH NO INSURANCE --
WHERE ARE THEY GOING FOR THEIR
00:20:24CARE?
THE ER, PROBABLY, TO GET SOME
00:20:28TYPE OF SERVICE.
THAT IS LIMITED.
00:20:31RIGHT THEN, THEY GET THAT, AND
THAT IS IT.
00:20:35ARE THEY GETTING THEIR
PRESCRIPTIONS?
00:20:36IT IS UNCLEAR.
THE PERSON THAT DOES HAVE
00:20:40COVERAGE THROUGH PRIVATE
INSURANCE OR MEDICAID GOES TO
00:20:45THE ER, GET SERVICES, AND THEN
THERE IS A HANDOFF TO A PRIMARY
00:20:50CARE PHYSICIAN.
WE HAVE BEEN MAKING SURE THAT IS
00:20:54TIED TO OUR MANAGED-CARE PLAN
PAYMENTS, SO THAT A PERSON CAN
00:20:58GO AND GET SERVICES.
>> I AM THINKING OF CRITICS LIKE
00:21:02MATT MAYER, FROM THE
CONSERVATIVE GROUP OPPORTUNITY
00:21:06OHIO, WHO WROTE A LETTER TO
LAWMAKERS, SAYING THERE IS NO
00:21:09IDEA HOW MANY PEOPLE, WITH
MEDICARE EXPANSION, WOULD ENROLL
00:21:13IN THE PROGRAM.
THE ESTIMATE IS 275,000 SOME
00:21:19PEOPLE ARE SAYING IT COULD BE
900,000.
00:21:21THESE PEOPLE COULD BE SICKER
THAN WE ESTIMATE THEY ARE.
00:21:24WHAT WOULD HAPPEN IF HE AND
OTHERS WHO SAY THAT ARE RIGHT?
00:21:27>> THERE ARE A COUPLE OF
DIFFERENT PIECES.
00:21:30WHEN WE LOOK AT THE NUMBERS OF
OHIO ONES WHO WOULD ULTIMATELY
00:21:35BE ELIGIBLE -- IN OUR OWN DATA,
IT IS ABOUT 700,000 PEOPLE.
00:21:39ANYTIME YOU BRING UP A NEW
PROGRAM, THE QUESTION IS, HOW
00:21:46QUICKLY DO PEOPLE COME IN?
HOW QUICKLY WILL PEOPLE SIGN UP
00:21:50FOR THE PROGRAM?
WITH CUYAHOGA COUNTY AND THE
00:21:53METROHEALTH SYSTEM, WE BROUGHT
UP AN EARLY EXPANSION.
00:21:57THEY ARE SERVING INDIVIDUALS
BELOW 138% OF POVERTY LEVEL
00:22:03ALREADY.
THEY, LIKE OTHERS, THOUGHT IT
00:22:09WOULD FILL UP THE FIRST DAY.
IT HAS NOT.
00:22:10IT IS FILLING UP ALL STOP PEOPLE
ARE MOVING TO THE PROGRAM TO GET
00:22:17SERVICES.
OUR EXPECTATION WAS THAT WE
00:22:21WOULD SEE ABOUT 370 THOUSAND
INDIVIDUALS COME INTO THE
00:22:23PROGRAM BY THE END OF THE BUDGET
PERIOD.
00:22:27COULD IT BE LARGER?
IT COULD BE.
00:22:30IT ALSO COULD BE SMALLER.
ONE OF THE THINGS AROUND THAT
00:22:37IS, JUST LOOKING AT THIS BUDGET,
THE FEDERAL GOVERNMENT PAYS 100%
00:22:41OF THE COST OF THOSE
INDIVIDUALS.
00:22:42EVEN IF MORE INDIVIDUALS CAME IN
FOR THESE TWO YEARS, THE FEDERAL
00:22:50GOVERNMENT IS PAYING 100% OF THE
COST.
00:22:51>> BUT EVENTUALLY THE STATE
WOULD HAVE TO TAKE OVER THE
00:22:56COSTS OR TAKE THOSE PEOPLE OUT
OF THE PROGRAM.
00:22:57>> THAT IS TRUE.
THE 100% SLOWLY GOES DOWN TO 90%
00:23:05FEDERAL REIMBURSEMENT, AND A 10%
STATE MATCH.
00:23:07IN OUR BUDGET PROJECTIONS, WE
ASSUMED MORE AND MORE
00:23:14INDIVIDUALS WOULD BE COMING IN,
AND THE STATE WOULD BE PICKING
00:23:18UP THAT 10%.
WHEN WE ARE LOOKING AT IT, THAT
00:23:22IS WHY WE WOULD NOT HAVE
PROPOSED TO EXTEND MEDICAID
00:23:28COVERAGE TO THOSE INDIVIDUALS IF
WE HAD NOT MADE THE REFORMS WE
00:23:31HAVE DONE OVER THE LAST COUPLE
OF YEARS.
00:23:32WHEN THE PROGRAM WAS GROWING
EIGHT PERCENT TO 10%, NOT
00:23:37SUSTAINABLE.
BUT BRINGING GROWTH DOWN TO
00:23:42THREE PERCENT, FOUR PERCENT --
WE ARE LOOKING AT THAT, AND
00:23:47PROJECTING THAT OUT OVER THE
YEARS.
00:23:48EVEN WITH THAT, WE ARE SAYING WE
COULD COVER THAT.
00:23:52WE COULD MAKE SURE THE PROGRAM
CAN COVER THOSE INDIVIDUALS.
00:23:56>> LOOKING AHEAD TO OCTOBER ONE
AND THE IMPLEMENTATION OF THE
00:24:04AFFORDABLE CARE ACT, AND ALL THE
THINGS THAT ARE GOING TO BE
00:24:05HAPPENING WITH THAT, AND
WHATEVER MIGHT HAPPEN WITH
00:24:09MEDICAID REFORM OR EXPANSION --
IS YOUR DEPARTMENT GOING TO BE
00:24:12READY FOR ALL THIS CHANGE?
>> WE ARE GOING TO BE READY.
00:24:15THE STAFF IS WORKING FAST AND
HARD.
00:24:18A LOT OF LATE NIGHTS AND
WEEKENDS TO PULL THINGS
00:24:22TOGETHER.
PART OF IT IS, IS THE FEDERAL
00:24:25GOVERNMENT GOING TO BE READY?
OUR DEADLINES ARE MORE AROUND
00:24:30JANUARY, RATHER THAN ON OVER.
WE HAVE TO BE ABLE TO INTERACT
00:24:35WITH THE EXCHANGE ON OCTOBER 1.
THAT IS FOR THE FEDERAL
00:24:38HEALTHCARE EXCHANGE.
>> IF THERE WERE AN EXPANSION,
00:24:42WOULD YOU HAVE TO HIRE MORE
PEOPLE?
00:24:44HOW LONG WOULD IT TAKE YOUR
DEPARTMENT TO GET READY?
00:24:47>> WE ARE READY.
>> RIGHT NOW?
00:24:51>> RIGHT NOW.
WE BUILT IN THE ABILITY TO DO
00:24:55EXPANSION.
ALL OF THE INDIVIDUALS WOULD BE
00:24:59MOVED INTO OUR MANAGED-CARE
PROGRAMS.
00:25:00THAT WAS OUR DISCUSSIONS WITH
THEM, THAT THEY WOULD HAVE
00:25:05NETWORKS READY TO GO.
OUR SYSTEMS -- WE BUILT ALL OF
00:25:09THOSE SYSTEMS TO BE ABLE TO
ACCEPT ALL THE NEW INDIVIDUALS
00:25:14COMING THROUGH THE PROGRAM.
WE ARE READY TO GO.
00:25:18THE BIGGER ISSUE IS, IF WE DO
NOT DO EXPANSION, WE HAVE TO BE
00:25:25NIMBLE ENOUGH TO TURN ALL THE
SYSTEMS OFF.
00:25:27THOSE ARE THE ISSUES WE ARE
DEALING WITH INTERNALLY.
00:25:30WHEN DO WE GET THAT DECISION TO
SAY SYSTEM ON, SYSTEM OFF,
00:25:37MAKING SURE THOSE THINGS HAPPEN
SMOOTHLY?
00:25:38>> THANK YOU FOR BEING HERE.
>> THANK YOU FOR HAVING ME.
00:25:42>>
AND THAT'S IT FOR THIS WEEK.
00:25:46FOR MY COLLEAGUES AT OHIO PUBLIC
RADIO AND TELEVISION, THANKS FOR
00:25:48WATCHING.
IF YOU'D LIKE TO ASK QUESTIONS,
00:25:50MAKE COMMENTS, OR WATCH THIS
WEEK'S SHOW OR EARLIER EPISODES,
00:25:52PLEASE VISIT OUR WEBSITE AT
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00:25:54YOU CAN ALSO CHECK US OUT ON
FACEBOOK, AND YOU CAN FOLLOW JO
00:25:56INGLES AND ME ON TWITTER.
AND PLEASE JOIN US AGAIN NEXT
00:25:58TIME FOR "THE STATE OF OHIO."
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Note : Transcripts are compiled from uncorrected captions