Three months after the I-Team first told you of changes that would impact some of the sickest and most desperate patients in Ohio, the Legal Aid Society of Greater Cincinnati filed a suit in Hamilton County Common Pleas Court Thursday, saying the state effectively has cut some of these patients from their longtime doctors, hospitals and clinics.
The patients are so sick the state has a special Medicaid program for them called the “Aged, Blind and Disabled” program. But since the end of April, hundreds of these patients in Greater Cincinnati may be getting no care.
Patient Hillary Phillips of Blanchester says, "I'm walking on a livewire practically, and it feels like I'm about ready to fall off of it."
Steven Reece of Cincinnati says, "I have to sit up in chairs at night because I can't sleep because I hurt. I have to walk the floors and cry. It's not right."
Phillips and Reece are two of at least 700 patients in our area who have begged the state to let them see the doctors and hospitals who've cared for them for decades. Reece talked to us through clenched teeth, the pain apparent on his face. He has epilepsy, asthma, lung disease, and is blind in one eye. But what's causing him constant pain is what looks like a giant tumor on his stomach, the result of 12 failed hernia operations. A drainage tube removes toxins from his stomach but the tube gets clogged, causing excruciating pain. It needs to be replaced every few months, but that's become a problem since April 30.
"I've been trying to find another doctor,” Reece says. “No one wants to take Buckeye insurance."
Buckeye is one of two insurance companies Ohio has contracted to insure its sickest Medicaid patients in our region. But just after the enrollment period ended in January, when those patients could have switched to another plan, Buckeye announced it was dropping one of the largest medical systems in our region, the Health Alliance, representing half a dozen hospitals, hundreds of doctors and clinics that specialize in treating the sickest patients. The Alliance also includes University Hospital, which has treated Cincinnati’s poorest patients throughout its history. And the Alliance coordinates care for patients with multiple problems so they can see dozens of specialists as one-stop-shopping.
Patients like Hillary Phillips see multiple specialists and now wonder "If I have a seizure, what's going to happen to me?"
Phillips, now 25, has been sick since she was a baby. She was diagnosed with diabetes at 22 months of age. She suffers from a myriad syndromes and diseases, including severe seizures that leave her paralyzed for months at a time. It took years to diagnose her, and all her various specialists worked together as a team to do it. "Without them I wouldn't be alive," she says.
Throughout her life, all those specialists have worked at the Alliance’s University Hospital and its various clinics. Now she can't see any of them. Instead Buckeye wants her to find all new specialists. She’d have to be driven all over the region to new doctors who wouldn't know her history or be at one location that could coordinate her intricate care.
Phillips’ mother Vicky says, "I believe this is jeopardizing her. I know it's jeopardizing her." She says in more than 20 years, she's navigated all Medicaid changes, but not this time. "I'm not asking for a handout. I'm asking for what's right," she says.
Phillips and Reece are two defendants in a case the Legal Aid Society of Cincinnati filed Thursday in the Hamilton County Court of Common Pleas.
Lead attorney Hugh “Trey” Daly says, "I blame the Ohio Department of Job and Family Services" for what’s happened to these patients.
Daly says the state failed on several levels. First, all the patients tell us no doctors on the lists Buckeye gave them as alternatives will accept them, so they're left with no medical care. Daly says "It feels like they've been given a bogus alternative."
There’s supposed to be an out for patients in this position. State law lets them apply for an exemption even in the middle of an enrollment period if they can prove they’re unable to get alternative care or that it would endanger them to switch. The law would let these patients change their coverage to the other Medicaid insurer in southwest Ohio that still carries the Alliance. That would let the patients keep their doctors, hospitals and clinics. But patients who called the state tell us workers wouldn't let them switch.
Daly says he thinks the state misled some of the people who called trying to stick with their doctors." He says, and patients confirm, that state Medicaid workers told them it was too late to switch, that they’d have to wait ‘til next year, or that this is a contract dispute and they didn’t have a right to change, which Daly says is not true. Why would the state do this? Daly has a theory: "The state has an interest in Buckeye surviving," he says.
Ohio Medicaid law requires at least two managed care plans for these patients, so they can they can choose. Daly says the state admitted to him that 700 to 1200 callers tried to leave Buckeye after its announcement, for the other plan that lets them stick with the Alliance. Daly says, "If 700 members were to be taken out of Buckeye overnight, that's at least 25% of their members in Southwest Ohio, so that would raise questions about the viability." He says the state may have discouraged patients from changing to ensure Buckeye would not pull out of Southwest Ohio so that the state still had two managed care plans to abide with Medicaid law.
That doesn’t sit well with Vicky Phillips: "They're not going to jeopardize my daughter's health just to keep an insurance company in business… It's not about the dollars. It's about her health. It's about her life."
She winces as her daughter asks, “Why? Why'd you do this? Why'd you let it fall through the cracks? I just want to know why."
For weeks, we asked the Ohio Department of Jobs and Family Services for an interview. In the end all we got was a statement from Brian Harter in the Communications Division, saying “ Due to possible litigation involving Buckeye Insurance, ODJFS will not be offering any comment at this time.”
Daly says the state has offered to help the few who've contacted him or us, but it won't fix the problem for the hundreds who've fallen through the cracks. Without new doctors, many of these patients are going to the emergency room, and we the taxpayers are paying for the most expensive kind of medicine, instead of cheaper regular checkups and upkeep.
