Disability Rights

What MyCare Ohio is Doing to PCA Care

This is the writing of my PCA, Kristy, who has worked for me for the last 12 years. Since I have been switched from Caresource through Medicaid, to MyCare Ohio’s Buckeye Health System, Governor Kasich’s plan to privatize healthcare for dual eligible Ohioans (those eligible for Medicare and Medicaid), Ohioans across the state have had their payments denied for doctors, durable medical equipment, nursing, PCA home healthcare, and medication. This is just the tip of the iceberg.

For the first time, here our story in Kristy’s own words below:

On or about July 7, 2014 I was finishing up the necessary items for my annual Medicaid review that all homecare workers have to do to maintain eligibility with the state of Ohio. One of the tasks is to visit a website and print out a care plan that goes in with your other documents. I went to go get this item and it was not available. It said (and still says) that Dominick is “Dis-enrolled” from the program. As such, the care plan is no longer available to me. Naturally, I asked him what this meant. After some phone calls he determined that when they switched him from traditional Medicaid to MyCare Ohio and the Buckeye Community Health Plan that his plan was moved to Buckeye and that any of his care workers would need to reapply to be approved for payment through the Buckeye system.

I received my last check from Medicaid on July 17, 2014. It was for one day’s work. I put in my checks weekly and am paid for the previous week. So the week prior I put in my entire check, but was only paid for one day because all of the other days fell in July and meant I had to bill Buckeye. I called Buckeye immediately when I found out and was told it would take two weeks to a month to be in the system and that I would then be taught how to bill. This call was made around July 10. I received my first paycheck on August 7. At this point I was owed over one month of money. I was paid roughly $550.00. The person that was supposed to help me learn how to bill, did not explain one thing, so all of my invoices ended up incorrect, as a result. I had to resubmit my claims. I mention this because I still have not been paid for that money.

Checks are received erratically. Normally, under Medicaid, I would bill on a Monday and as long as my invoice was submitted by 5 PM, I would receive my check on Wednesday evening via direct deposit. Now, sometimes I receive a check and sometimes I do not. I was informed that if I billed on a different day, then I might have better luck. So, I started billing on Fridays. This week I did not receive a check. I was told there was a glitch in the system and that people should be getting paid again, next week.

I have received some of the money owed to me, but I am still owed thousands of dollars. For the past month, on top of the back pay that has been owed to me, I have been short around $300 per paycheck. That is nearly an additional paycheck per month that I am missing. I have been incredibly proactive dealing with provider services to get this fixed. In late August, I began dealing with Laura, one of the people that work in provider services. She told me she was going to help me get paid and that I should call her directly. She said I should not deal with member services because they are “messing things up.” On August 30, she asked me to send her an email stating all of the claims that were wrong and needed to be fixed.

She returned my email claiming that I had been paid. I had to explain that I was paid incorrectly and that I resubmitted and was waiting to be paid for the correct amount. It’s worth noting that I had previously talked to who I was told was her supervisor, Rena, and she told me that when you resubmit a claim like I had done, it would take about three weeks to be paid. I resubmitted those claims in August and it is now October. Shortly after sending Laura all of the claim numbers to the incorrect claims and explaining the problem, I was told that she would be meeting with a claims specialist and she was working on things.

In September, I received at least two emails with her telling me that she was working closely with someone and that my problems should be resolved shortly. In that time, I spent all my savings on bills and when I did receive money from Buckeye for my paycheck I often paid bills ahead because I was afraid I would not receive a paycheck the next week or if I did that it would be incorrect. Any money I had in savings was spent on living expenses.

A few days ago, Laura emailed again asking for my pay records. The state of Ohio has PCAs sign in and out of each shift. During the review they use these records to match up your payments. You are required to show these once a year during your review. I was informed when I passed my review in July that I wouldn’t have another review until at least July 2015, a year later. Regardless, I need to be paid, so I gathered a month’s worth of identical pay records and sent them to Laura. She stated that she could not open the attachment and asked me to fax them. This occurred this morning.

I did not receive my paycheck and was upset. My rent is due this week. Technically, it was due on the 1st, but I have a grace period until the 5th. I told her that I would have to borrow money to fax the papers and I asked why I did not receive my paycheck stating that if I am unable to pay my rent (I do not have enough money in my checking account to do so) that I could end up homeless.

Laura called me within the hour. In hindsight, I wish I had recorded the phone call. She wanted to address the fact that I said I could be homeless and pointed out that I have been paid nearly every week (the last three weeks I did receive a portion of my paycheck) and so there was no reason I could not pay my rent. I told her that I did not have the money to do so and regardless, that paycheck is owed to me. She continued to be very cavalier and rude about the matter. I asked her if she was paid weekly and she said yes, but she pointed out that she does not make nearly what I do. It then became clear to me that this could easily be one of the things holding my paycheck up. I will admit that I yelled on the phone. She repeatedly tried to cut me off and for weeks I have tried to be nice. At this point, I am wondering if I will ever receive my money. When she realized I was not going to back down that’s when Laura tried to point out who was in control.

She mentioned to me that it was suspect that Dominick and I live together. I have been Dominick’s PCA for twelve years. I have lived with him that entire time. I did it free for a number of years and then Medicaid in two states has paid me to do it, Ohio being the second one. There have been a number of case workers, nurses, and doctors involved in Dominick’s care plan and no one has had any reason to assume that I do not do my job. Furthermore, her job is to see that I get paid, not determine the validity of my paycheck. That is the job of his care manager, who actually determined I deserved an extra hour of pay, for the large amount of work I do.

Prior to the switch to Buckeye it was determined that it was fine that we live together because Dominick has lived with me for 8 years prior to this and because he has asthma and cannot be left alone for significant amounts of time. Having me in the same house pretty much ensures that the state does not need to pay for 24/7 care.

When I explained that I have passed state reviews and that Medicaid has no problem with us living together I was told….”Medicaid does not pay you anymore. Buckeye does. Things are different now.”

I swore at her in my frustration and she said she didn’t appreciate being sworn at. I said I did not appreciate her treating me the way she was. She told me she was calling to get the information she needed to see if I could get paid. I had sent her the information and she confirmed she received it, so that wasn’t the reason she called. I asked her if she needed anything else, and when she said no, we both hung up. I haven’t heard a word from her since.

To be quite honest, it feels very clear to me that Laura is the one that is causing some or all of the problems with my paycheck. I understand she is frustrated that she does not make what I make. She also does not work 13 hours a day, seven days a week and she hasn’t done that for 12 years. I, personally, do not understand her frustration because the amount of money would be paid to someone, whether it was one PCA or six. This is the money the state has allotted for Dominick’s care. It’s also the money that Buckeye is holding onto, not paying people who desperately need it.

I cannot imagine not helping Dominick with his needs. I do everything I can to make sure he is comfortable and that all the things he needs done that he cannot do for himself are done. However, I cannot work out of the house and care for him at the level of care he needs. This is why the pay from Medicaid has allowed me to stay at home and see that he is taken care of. If Buckeye chooses to hold my paycheck hostage out of malicious intent or incompetence, I will get to the point where I have to find a way to bring money into our home. Otherwise, I could end up homeless and so could Dominick. Going out of the home for work means that his care suffers. No one is going to work for him if he is unsure when or if they will be paid. I will have to make money some how so I won’t be there to care for him, all the time. It is the people with disabilities and those that care for them who are suffering the most in all of this.

We have started a GoFundMe, in an attempt to raise enough money, to put aside for rent, for the next few months. The funny thing is, Kristy had almost paid off all her debt, excluding student loan debt, by saving every penny she makes, not splurging, and basically, in just a few months, all her hard work, to become debt free, could be thrown away. This is not a person who spends in excess. She has literally used every cent left in savings.

I have the privilege of living in her house, rent free. I pay for my own bills and food, but I don’t make enough to pay her for care. If she cannot pay rent, we’re both out of a home. I’m asking from the bottom of my heart, to help us in a time of need.

Please check out the GoFundMe Here.

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