Friday, August 26, 2011

In Missouri, Medicaid recipients forced to wait, hope

From The News-Leader:

Katie Haverstick, 32, (pictured) has spina bifida, a birth defect that has left her in a wheelchair and prone to bedsores. She can't get out of bed or take a shower by herself.

The state of Missouri considers the Springfield woman disabled enough that she could live in a nursing home. Haverstick has spent about two months waiting for home health care in the apartment complex where she lives because of delays by an Indiana company that Missouri hired to verify she needed the care.

"I need help," said Haverstick, who has relied on her mother and stepfather.

She learned Wednesday that her home health care could start soon, but hundreds of other disabled or elderly Medicaid recipients across the state are still waiting to learn if they qualify for home health care or if their health care can be modified.

The Missouri Alliance for Home Care, an industry group of home health agencies, has asked the state to terminate its contract with the Indiana company, SynCare LLC. The contract, worth up to $5.5 million, calls for the company to screen more than 50,000 Medicaid recipients. It began doing the assessments in May.

Stephanie DeKemper, the CEO of SynCare, said in a letter emailed to the News-Leader today that it was expecting to process only 4,400 cases a month, but health care providers have been sending more cases to them with more than 1,000 calls a day. The state hired SynCare after questions were raised about whether it was a conflict of interest to have the health care providers assess whether someone was eligible for services that the health care providers would financially benefit from.

“Providers used the loophole of requesting changes to jump the line, so to speak,” DeKemper said. “That has resulted in over 1,000 calls a day, and instead of processing the backlog of 4,400 per month to processing all 52,000 backlog/conversion cases. We are receiving requests on participants we have not received from the state.”

Jacqueline Lapine, a spokeswoman for the state Department of Health and Senior Services, said the department "is committed to ensuring that participants receive services in a timely and accurate manner."

"We are aware of the problems SynCare has encountered in these initial months of the contract, and will continue to hold them accountable under the terms of the contract," Lapine said.

Officials at Oxford HealthCare said their company had more than 160 people waiting to hear from SynCare, with waits as long as 104 days. The average wait so far in Greene County for Oxford is 57 days.

Cheryl Fitch, the vice president for Oxford, said the patients are very fragile.

"The only reason they can stay in their homes is because of what we do for them," Fitch said. "Many times they don't have family to care for them. They're sitting there with no help."

The contract requires SynCare to complete assessments that need to be done in person in 15 calendar days. The company can be fined if it fails to do this in more than 5 percent of the cases each month.

The state has been corresponding with the company trying to address issues.
On Aug. 15, Celesta Hartgraves, the director of the Division of Senior and Disability Services, said in a letter to the CEO of SynCare, Stephanie DeKemper, that the state will be reviewing the company's billing at the end of September to see if SynCare is doing its assessments on time.

"If not, we will be assessing liquidated damages as stated in the contract," Hartgraves wrote.

The company laid off 29 employees earlier this month, the St. Louis Post-Dispatch reported.

On Tuesday, Hartgraves wrote DeKemper that the contract requires it to have at least 130 full-time staff doing assessments, but a staff listing provided to the state shows only 119 employees. Hartgraves asked for a written plan to be submitted Wednesday to comply with the staffing requirements.

DeKemper said that SynCare has added 40 employees to its call center to reduce wait times and recalled half the employees who were laid off. She said SynCare has processed 10,193 reassessments.

“We are getting to people as fast as we can under the circumstances,” DeKemper said. “Many of the participants being reported as experiencing adverse affects were waiting for services for a very long time and some participants have been waiting for up to five years for review of their care plan.”

Dru Sears, 70, of rural Springfield, asked SynCare in June about increasing the number of hours a home health aide helps care for her mother, who is 95 and has Alzheimer's. An aide currently provides 21/2 to 3 hours of help five days a week. She hasn't heard back from the company.

Sears' husband, who may also have dementia, has been in a nursing home but is coming home today. Sears uses the time the aide is at the house to do errands like going to the grocery store or the doctor.

"Every day I wake up and go to bed praying, 'God, you need to keep me healthy. I have people counting on me,' " Sears said.